CORRUPTION: Medicaid Fraud Control Units aren’t doing enough to control fraud. (WaPo editorial, July 14, 2026)

Washington Post editorial:

Medicaid Fraud Control Units aren’t doing enough to control fraud

Indictments and convictions are down, despite a surge in funding.

July 14, 2026 at 1:26 p.m. EDTToday at 1:26 p.m. EDT

3 min

 

Mehmet Oz, the administrator of the Centers for Medicare and Medicaid, speaks in Milwaukee on July 8. (Scott Olson/Getty Images)

Every state has a Medicaid Fraud Control Unit that is responsible for investigating and prosecuting health care providers who bilk the system. Many of these offices have been neither aggressive about nor effective at policing the spending of federal money.

Spending on Medicaid increased 68 percent from fiscal years 2019 to 2025, and federal grants to the anti-fraud offices grew 40 percent. Yet the rate of new investigations being opened fell 17 percent, indictments dropped 16 percent and convictions decreased 22 percent during that period.

These are the findings of a new study by the Foundation for Government Accountability, a conservative think tank. “As waste, fraud and abuse in Medicaid has continued to climb, it’s clear that the entities responsible for prosecuting, deterring and convicting those fraudsters have let the American taxpayer down,” Hayden Dublois, the report’s author, said in an interview.

The inspector general at the Department of Health and Human Services reported in March that Medicaid Fraud Control Units have recovered $4.64 for every $1 spent. That impressive top line oversimplifies underwhelming performance.

The new study shows that the total amount of fraudulently spent Medicaid money recovered by states has been flat in nominal dollars but fallen when adjusted for inflation. There have been some exceptional recoveries, like a $650 million case in Virginia, but 19 of the 53 anti-fraud units recovered less money than they received in federal grants last fiscal year. (In addition to the 50 states, the other three offices are in D.C., Puerto Rico and the Virgin Islands.)

For every $1 billion in Medicaid spending, an average MFCU conducts only 15 investigations — and achieves less than one conviction, according to the report.

Scrutinizing these offices has become a focus of the Trump administration’s efforts to crack down on fraud following scandalous abuses in Minnesota. Two weeks ago, HHS decertified New York’s unit, which cuts off federal funding.

Last month, the agency also declined to recertify Hawaii’s Medicaid Fraud Control Unit on the grounds that the office obtained no indictments or criminal convictions from 2022 to 2025. The state responded that it has recovered $14 million from civil cases since 2021.

Targeting waste and abuse is necessary but not sufficient to save Medicaid, whose costs have ballooned in unsustainable ways because of the Affordable Care Act. Advocates for expanding coverage should be the angriest that states aren’t fighting harder, because the more fraud is allowed to fester in the system, the harder it becomes to justify spending more than $900 billion a year on Medicaid.

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