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Facility charges for Medicaid enrollees with type 2 diabetes were significantly higher than professional charges in 2017. Enrollees that required inpatient care faced higher costs than those that received outpatient care.

High price for hospital inpatient services

Both charges are considerably higher for inpatients, but the facility charges are particularly costly. Inpatient care requires an overnight stay and charges help to cover the costs of operating the hospital or clinic. At hospitals in the United States, the cost per inpatient day averaged more than U.S. dollars in 2018. Outpatients do not require an extended stay and are free to leave once the appointment or procedure is over.

Medicaid physician payment

In general, private insurers pay much more for physician services than Medicaid. As a consequence, some physicians are reluctant to accept Medicaid patients. The process of billing Medicaid beneficiaries is also more difficult because the requirements vary from state to state. Some general rules apply, but the complexity of the program creates an opportunity for exploitation. Medicaid fraud is a serious issue in the U.S. and common fraud cases involve wrongdoings such as false claims and billing for services that were never provided.