Universal HealthcareBy NextBestFit
Phase 5: Stabilize & govern · Step 5.2

Run program integrity & fraud control

Year 1 onward · UHA Program Integrity; HHS-OIG; DOJDiscuss this step
operationallikelihood: mediumimpact: medium

Fraud concentrated on one payer

Medicare FFS's 7.7% improper payment rate applied to UHP benefits would be about $297.3B.

Early warning signs
  • Improper payment rate
  • Billing anomalies
Mitigation
  • 2.5% admin budget with integrity funding
  • Prepayment review in high-risk categories

Implementation risks

RiskMitigation
Medicare FFS's improper payment rate was about 7.7% in FY2024. Applied to UHP benefits, that would be about $297.3B a year.Most improper payments are documentation errors, not fraud; budget enough for review.