More than three-quarters of Medicaid's improper payments in fiscal 2025 resulted from insufficient documentation rather than fraud or abuse, according to a Congressional Research Service report released Oct. 7. The nonpartisan research agency cited estimates from the Centers for Medicare and Medicaid Services, which put Medicaid's improper payment rate at 6.12%, or about $37.39 billion.
The distinction matters for the roughly 85 million people who rely on Medicaid. An improper payment is not the same as a stolen dollar. In most cases flagged in fiscal 2025, the problem was insufficient documentation, such as no record that an enrollee's eligibility, including income, had been verified.
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