By NextBestFitOne payer becomes one target
A single national payer concentrates fraud risk and cyber risk; improper payments of 7.7% at national scale would be about $300B.
Evidence
- Medicare FFS improper payment rate about 7.7%.Sources: CMS (2024)
Who's affected
Who is hurt
- Taxpayers and public budgets: A single national payer concentrates fraud and cyber risk.
Who gains while it lasts
- Fraudulent operators and cybercriminals: Concentrated national payments provide a single fraud target.
Under your mix of paths
Paths that create or worsen it
Paths that fix or soften it
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Root causes
- Pay-and-chase claims processing
Related costs
Open questions
- How should one payer verify claims without burdening honest providers?
Caused or worsened by these paths
This problem only matters if one of these paths is chosen.
Public administration with a cost targetInsurer overhead and profitChosen
A public administrator takes over administration while public agencies may underinvest in fraud control.
Solution paths (2)
Open a path for what it fixes, what it creates or worsens, who gains and who loses, precedents, and how it connects to other paths. See all paths as a decision tree.
Reserve a share of administrative spending (e.g., 0.3% of benefits) for fraud detection, audits, and prosecutors.
- +One payer becomes one target
- +Fraud and improper payments
- −About $1 trillion a year in administrative cost
- −Adds paperwork, coordination, or complexity
Split claims processing among regional administrators (public or contracted) that compete on integrity metrics.
- +One payer becomes one target
- −About $1 trillion a year in administrative cost
- −Targets and quality metrics invite gaming