Vice President JD Vance is right about one thing. Fraud in government programs is not a victimless crime. Every fraudulent Medicare claim, every ineligible Medicaid payment and every improperly issued SNAP benefit represents money taken from taxpayers and from the people these programs were designed to help. As Vance recently argued, fighting fraud must become a national priority.
But the conversation cannot stop with fraudsters.
There is another side of the fraud equation that receives far too little attention: the government agencies entrusted with administering these programs. Fraud rarely flourishes because criminals are exceptionally clever. It flourishes because institutions fail. Those failures are often dismissed as bureaucracy or incompetence, when in reality they represent a profound breakdown in accountability.
Incompetence can be just as costly as corruption. It’s not enough that legislation is passed without oversight.
Every major fraud scheme exposes the same uncomfortable truth. Someone ignored warning signs. Someone failed to verify eligibility. Someone overlooked repeated audit findings. Someone approved payments despite obvious irregularities. The result is billions of taxpayer dollars flowing out the door while agencies insist they followed procedure.
That should not be acceptable. The Government Accountability Office has repeatedly designated many federal benefit programs as “high risk” because of persistent improper payments and weak internal controls. Improper payments across federal programs have reached hundreds of billions of dollars annually, with Medicare and Medicaid accounting for a significant share. While not every improper payment constitutes fraud, every improper payment reflects a failure of oversight that creates opportunities for fraud to thrive.
History provides numerous examples.
During the pandemic, unemployment insurance programs paid benefits to prisoners, deceased individuals and organized criminal networks because identity verification systems were inadequate. Billions were lost before agencies reacted. I saw that firsthand.
The Minnesota “Feeding Our Future” scandal revealed how nonprofit organizations allegedly diverted hundreds of millions of dollars intended to feed children while government oversight repeatedly ignored obvious warning signs. The fraud was breathtaking, but so was the administrative failure that allowed it to continue for years.
Medicaid has experienced similar failures. Audits have repeatedly identified payments made on behalf of ineligible beneficiaries, duplicate claims and providers who should never have remained enrolled. These are not simply isolated mistakes. They reflect systemic weaknesses in the agencies responsible for safeguarding taxpayer dollars.
Yet when fraud is uncovered, attention almost always focuses on the individuals who committed the crime. Prosecutors bring charges. Headlines celebrate convictions. Nobody questions the employees in the agencies, and they are given tremendous immunity.
The bureaucrats who failed to prevent the fraud often remain anonymous.
Imagine if a publicly traded company repeatedly lost billions because executives ignored internal controls. Shareholders would demand resignations. Boards of directors would insist on accountability. Regulators would investigate management failures.
Government should not operate under a different standard.
Public agencies have a fiduciary responsibility to taxpayers. That responsibility extends beyond writing regulations. It requires implementing effective oversight, responding promptly to audit findings, modernizing outdated technology and accepting responsibility when preventable failures occur.
There is an even broader issue at stake.
When agencies believe they are effectively above the law, accountability begins to erode. Deadlines become optional. Audit recommendations are ignored. Internal procedures replace statutory obligations. Decisions become insulated from meaningful scrutiny because there are few consequences for getting them wrong.
That culture does not merely waste money. It undermines public trust. Legislation never addresses this.
Taxpayers deserve confidence that government officials are held to the same standards of accountability that they impose on citizens, physicians, hospitals, businesses, and contractors. We routinely sanction providers for billing errors, revoke licenses for misconduct and prosecute individuals who misuse public funds. Government agencies should be expected to demonstrate the same commitment to competence, transparency, and adherence to the law.
This should not be a Republican issue or a Democratic issue.
Every taxpayer has an interest in ensuring that government programs operate with integrity. Every beneficiary depends on these programs remaining financially sustainable. Every dollar lost to fraud or administrative incompetence is a dollar unavailable for legitimate patients, families and vulnerable Americans.
If the Trump administration’s anti-fraud initiative succeeds, it should not be measured solely by the number of fraudsters prosecuted or dollars recovered. It should also be judged by whether agencies themselves become more accountable, more transparent and more competent.
Fraud does not occur in a vacuum. It requires opportunity. More often than not, government creates that opportunity through weak oversight, poor management and a culture that rarely holds itself accountable.
Fighting fraud means more than catching criminals.
It means fixing the institutions that made the fraud possible in the first place.
Sreedhar Potarazu is an ophthalmologist and former healthcare executive.
