DHHS details program-integrity work, cites staff shortfalls and 2025 fraud figures

Department of Health and Human Services officials outlined how the agency identifies and responds to fraud, waste and abuse in Medicaid and benefit programs, saying detection relies on referrals from managed care organizations and community sources plus internal data analytics. Meredith Tellez, director of the division of program quality and integrity, said DHHS uses CMS definitions of fraud, waste and abuse and supplements investigations with training, clarified policy and, where necessary, regulatory changes.

Tellez told the committee that the Medicaid program-integrity unit is resourced for 7.5 positions but only 3.5 are filled. "We were actually down… we had 7.5 positions in our Medicaid program integrity unit and only 3.5 of those positions are filled right now," she said, adding the department is seeking hiring waivers and reallocating staff to bolster capacity. She and others said more investigative capacity makes evidence packages easier to prosecute at the state and federal levels.

The presentation included 2025 statistics: DHHS received 1,447 referrals (the majority SNAP), about 280 over-issuance errors, 364 fraud investigations, 111 SNAP disqualifications and 27 TANF disqualifications. The department established overpayment claims of $710,000 for SNAP, $200,000 for cash benefits and $35,000 for childcare overpayments. Tellez said three convictions for welfare fraud have been recorded "totaling $200,000" but cautioned some cases remain open. Department staff also described limits of current federal systems for identifying multi-state EBT use and said the agency is developing expenditure-pattern analyses to narrow actionable cases.