Semester

Fall

Date of Graduation

2025

Document Type

Dissertation

Degree Type

DBA

College

Chambers College of Business and Economics

Department

Accounting

Committee Chair

Jack Dorminey

Committee Member

Daniel Bonneau

Committee Member

Scott Fleming

Committee Member

Elizabeth Vitullo

Abstract

Medicaid is the largest public health insurance program in the United States, providing critical coverage to over 78 million low-income individuals, children, and people with disabilities. While Medicaid fraud has received extensive public and political attention, empirical research examining enforcement outcomes across states remains limited. This study analyzes state-level Medicaid fraud metrics from 2010 to 2022 to evaluate how structural and policy changes, particularly rising managed care enrollment and the implementation of the 2010 Affordable Care Act and the 2016 Managed Care Final Rule, have shaped enforcement outcomes. Using random-effects generalized least squares (GLS) and fixed-effects panel regression on a 50-state dataset, I examine how program design, staffing capacity, and policy environments influence civil and conviction rates and financial recoveries. The results indicate that states with higher managed care penetration and lower investigative staffing experienced declines in enforcement actions but greater financial recoveries when fraud was detected, suggesting that privatization may reduce consistency while amplifying the scale of recoveries from large, uncovered schemes. These findings underscore the importance of aligning Medicaid oversight capacity with program complexity and ensuring that privatized structures maintain accountability in an evolving healthcare landscape.

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