WASHINGTON — A House committee has initiated an inquiry into potential Medicaid fraud across 10 states, including New York and California, seeking records to “ensure program integrity nationwide,” as exclusively reported by The Post.
On March 3, Republican leaders from the House Energy and Commerce Committee dispatched letters requesting documents and communications from the governors and leaders of state health agencies in New York, California, Colorado, Massachusetts, Maine, Nebraska, Oregon, Pennsylvania, Vermont, and Washington State.
These letters highlighted recent reports and prosecutions involving fraudulent activities in the respective states.
In New York, for instance, two individuals connected to adult day care centers in Brooklyn and a home health care organization admitted guilt in January for defrauding the Medicaid program of $68 million.
Another fraudulent operation mentioned involved $120 million allegedly siphoned from Medicaid and Medicare funds by owners of Queens-based adult day care centers and a pharmacy engaged in kickbacks.
The Empire State allocated $115.6 billion to Medicaid for nearly 7 million residents in the fiscal year 2025. However, according to Gov. Kathy Hochul’s budget proposal for this year, the program’s expansion is deemed “unsustainable.”
Other letters to California, Colorado, Pennsylvania and Nebraska noted massive percentage increases in spending on Medicaid services in recent years.
“Fraud shouldn’t be a partisan issue,” Energy and Commerce Chairman Brett Guthrie (R-Ky.) said in a statement. “It’s our most vulnerable Americans who are most at risk from fraudsters diverting precious resources intended for critical, needed care.”
“We owe it to our fellow Americans to preserve the Medicaid program for those that need it most, and states have an important role to play in ensuring that Medicaid programs operate with integrity,” he added. “The Committee will continue to combat rampant waste, fraud, and abuse across the entire country.”
The letters all cited reports of fraudsters bilking taxpayer funds in Minnesota — as well as Trump administration probes that recently led to the withholding of more than $250 million in Medicaid funding.
That fraud was perpetrated through “overbilling, falsifying records, identity theft, and phantom claims in Medicaid social service and health programs for the elderly and disabled, children with autism, people struggling with substance use disorders, and homelessness,” wrote Guthrie and two other GOP subcommittee chairmen, Rep. John Joyce (R-Pa.) and Rep. Morgan Griffith (R-Va.).
The House Energy and Commerce Committee’s probe comes after a hearing early in February that heard testimony from experts about kinds of fraud schemes — including those with “high rates” of abuse such as Applied Behavioral Analysis (ABA), services for children with Autism Spectrum Disorder (ASD), substance abuse treatment centers, home and community based services and more.
Certified fraud examiner Jessica Gay told the House committee that the vulnerable programs “should be on every state’s radar.”
“If a state isn’t monitoring ABA services closely, they are likely missing a considerable area where FWA is committed,” Gay said.
“Medicaid fraud robs both taxpayers and patients, and we will pursue it wherever it hides,” Joyce said in a statement.
“Republicans in Congress will continue to do the necessary legwork to investigate allegations of waste, fraud and abuse within our Medicaid system,” added Griffith.
New York Gov. Kathy Hochul accused the House Energy and Commerce Committee of “playing partisan games,” but vowed to continue to go after “bad actors in the Medicaid program.”
“Congressional Republicans should learn from Governor Hochul’s dogged efforts to root out waste, fraud and abuse – including sweeping CDPAP reforms that shut down hundreds of wasteful Medicaid middlemen and saved over $2 billion for state and federal taxpayers while protecting home care for those who need it,” a spokesperson for Hochul said in a statement.
A spokesperson for California Gov. Gavin Newsom insisted the state has tackled Medicaid fraud for years.
“California holds a strong commitment to protecting taxpayer dollars and the integrity of public programs like Medi-Cal. The state has taken action against Medi-Cal fraud for years and utilizes robust oversight mechanisms to protect the integrity of Medi-Cal programs and preserve public confidence,” the spokesperson said.
Colorado “takes oversight of our Medicaid programs very seriously, and prioritizes finding and rooting out fraud when it occurs, including referring to law enforcement,” according to a statement from Gov. Jared Polis’ spokesperson.
Reps for the other seven governors’ offices and state health agencies in the states did not immediately respond to a request for comment.
