Chair opens House Energy and Commerce subcommittee hearing on state Medicaid fraud and oversight gaps

The chair of the House Committee on Energy and Commerce opened a subcommittee hearing on state Medicaid program integrity, saying fraud in Minnesota, California, New York and Ohio has cost millions and harmed patients.

"Fraud is not isolated to these four states," the chair said, summarizing the panel's months‑long review and the decision to call state Medicaid directors to testify. The hearing, titled "State Medicaid Program Integrity: Examining Fraud Risks and Oversight Deficiencies," will examine what states are doing to address fraud in the federal‑state Medicaid program.

The chair highlighted recent enforcement actions and alleged schemes: a recent $90 million takedown in Minnesota involving autism therapy, housing supports, home health care and personal care services; a California case in which a defendant pleaded guilty to $270 million in fraudulent prescription drug claims and a separate $267 million hospice‑benefits fraud case; $226 million in social adult day care fraud charged in New York so far this year; and a $42 million takedown in Ohio tied to therapeutic behavioral health services for children and young adults, along with more recent charges alleging hundreds of thousands of dollars in in‑home service fraud.

The chair warned of patient harm when services are billed but not provided, saying elderly and disabled patients can miss essential in‑home care, children may lose therapies they rely on, and patients who depend on transportation assistance can miss appointments.

Describing the subcommittee's work, the chair said investigators have held two prior hearings, sent letters to 11 states requesting documents and reviewed more than 90,000 pages of materials produced to the committee. "It is clear that some states are not doing enough to safeguard the Medicaid program, and gaps remain in program integrity requirements that are opening the door far too wide to fraud," the chair said.

The chair commended the administration for creating a task force to eliminate fraud and said the Centers for Medicare & Medicaid Services and the Office of Inspector General are using their authorities to hold states accountable. "Fraud is not and should not be the cost of doing business," the chair added, urging states to strengthen safeguards.

The hearing will continue with testimony from state Medicaid directors and other witnesses. The chair closed his opening remarks by thanking the witnesses for appearing and saying the committee looks forward to learning more about their anti‑fraud efforts.