The U.S. health system still suffers from systematic concerns over fraud and abuse, according to a federal report released Wednesday.

The U.S. Office of the Inspector General issued the report that showed that Medicaid's contracts to outside healthcare agencies are rife with concern over abuse and misspent money, despite policies and regulations to avoid wasting money.

The contractors - known as managed care entities or MCEs - have helped track some of the $374 billion that Medicaid spent in 2009.

Federal regulators surveyed and interviewed 46 of the MCEs across 13 states and found that a whopping 20 of them recovered payments from healthcare providers that resulted from fraud or abuse in 2009, the study reported.

The most prevalent concern came from medical services billed, but not delivered - akin to charging for an X-ray only to forgo the procedure.

The office made several recommendations, including an update to the 2000 abuse and fraud guidelines plus a verification system for provided services.

The results affect some 72 percent of Americans enrolled in Medicaid-based managed care.

The MCEs gave training to their staffs on fraud and abuse and all 13 states in the sample said they were reviewing their abuse and fraud reduction plans.

The Medicaid offices said they would comply with the recommendations, according to the report.