AN EASY WAY TO DEFEAT MEDICAID FRAUD

States would do more to police improper payments if they had better financial incentives to do so.

By Vivek Ramaswamy



There’s a simple way to lower healthcare costs without requiring Americans to bear unacceptable trade-offs: prosecute Medicaid fraud and put the recovered funds back into citizens’ pockets. In recent weeks, the Trump administration has been focused on this, but long-term progress requires changing the misaligned incentives between federal and state government.

The underlying problem is that Medicaid rewards states with more money when they waste money. Here’s the solution: a deal with the federal government that allows states that combat Medicaid fraud to keep a greater share of what they save. If I am elected governor of Ohio in November, my state will be ready to commit in January.

Consider the math facing a governor today. In Ohio, about 65% of every traditional Medicaid dollar comes from the federal government. That means for every dollar a state recovers by hunting down a fraudulent home health agency or a phantom hospice, less than 35 cents return to the state treasury. The rest goes back to Washington.

Now reverse the math. On Jan. 8, 2021, the first Trump administration approved an agreement that for the first time let a state, Tennessee, keep a share of the savings it generated through better management of its Medicaid program. By late 2025, TennCare’s “shared savings” had exceeded $1 billion, money the state has used for rural health, coverage for children and pregnant women, and no-interest disaster-relief loans for counties hit by 2024’s Hurricane Helene. Dollars recovered from fraudsters became dollars spent on care for law-abiding families.

A more tailored version can focus on fraud recovery alone, creating incentives for state and local law-enforcement agencies to investigate and prosecute the criminal misuse of Medicaid dollars. The increased proceeds can then be reinvested in healthcare.

Read Vivek's full op-ed at WSJ.com. 

Learn more about Vivek's plan to crush Medicaid fraud and make healthcare more affordable here.

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About Vivek Ramaswamy

Vivek Ramaswamy is a devoted husband to Apoorva and a proud father of two sons and a daughter. Together, they are raising their family just outside Columbus, embracing the values that shaped Vivek’s life. Born and raised in Cincinnati, he learned the importance of hard work, free enterprise, and personal responsibility—principles that have guided his journey. A businessman, entrepreneur, and unapologetic conservative, Vivek is ready to lead Ohio with a bold vision and strong leadership, making our state the best place to live, work, and raise a family—built on economic freedom, limited government, and individual liberty.

About Rob McColley

Rob McColley is a man of deep Christian faith, a devoted husband, and a father of three who is running for Lieutenant Governor to help Vivek deliver a bold vision that expands opportunity for every Ohioan. First elected to the Ohio House of Representatives in 2014, Rob has earned a reputation as a principled statesman and effective leader. After serving in both House and Senate leadership positions, Rob was unanimously elected President of the Ohio Senate in January 2025. His strong conservative record includes cutting taxes, reducing government red tape, and ensuring Ohio never again repeats the overreach of the COVID-era shutdowns led by Democrat Amy Acton.