U.S. House panel examines Medicaid fraud oversight across states

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Medicaid fraud oversight hearing

Highlights

At a House Subcommittee hearing, lawmakers criticized California for delayed production of Medicaid fraud audit documents requested since March 3, highlighting gaps in state oversight.
Ohio was praised for cross-agency Medicaid fraud coordination, as the state ranks fourth nationally for Medicaid expansion and focuses on service continuity and compliance improvement.
A CMS-requested revalidation process in 14 high-risk Medicaid programs led to over 3,400 provider disenrollments and subsequent restoration of billing privileges to more than 2,100 providers after appeals.

Hearing centers on audits and provider screening

As reported by the House Committee on Energy and Commerce, the Subcommittee on Oversight and Investigations holds a hearing on Medicaid program integrity, with Chairman John Joyce saying fraud affects every state and has drained public resources for decades.

Joyce says states can no longer do the bare minimum and must confront fraud directly to protect both the Medicaid program and patients who rely on it. The hearing, titled State Medicaid Program Integrity: Examining Fraud Risks and Oversight Deficiencies, forms part of a wider committee probe into Medicaid programs across the country.

At the hearing, Chairman Brett Guthrie presses California official Mr. Sadwith over document production tied to committee requests issued on March 3, including audits related to fraud, waste and abuse from Jan. 1, 2021 to the present. Guthrie says the committee did not receive a single California audit document until 7 p.m. the night before the hearing, despite knowing such audits had been conducted.

Sadwith acknowledges the committee's frustration and says California has been working with staff while providing information, including a list of 26,000 audits and investigations conducted over the past five years. He also says some requested audits could affect ongoing law enforcement investigations and that further information can be provided at the appropriate time.

Congressman Gary Palmer questions Mr. Connolly about a CMS-requested revalidation of providers in 14 high-risk Medicaid programs involving nearly 5,600 providers. Palmer says the initial process led to more than 3,400 disenrollments, or about 60% of enrolled providers, and asks why billing privileges were later restored for more than 2,100 providers that appealed.

Connolly says those services remain subject to enhanced pre-payment review and other high-risk program requirements. When pressed on whether many disenrolled providers had previously been flagged by the agency, Connolly says he would need to confirm the details.

National compliance risks draw wider scrutiny

Lawmakers use the session to underscore that the committee's review extends beyond individual states and reflects broader concern over how Medicaid agencies detect fraud, handle appeals and coordinate with enforcement bodies. The hearing keeps attention on whether delayed records, incomplete responses and uneven screening standards are limiting oversight of one of the largest public health programs in the U.S.

Congressman Michael Rulli points to Ohio as an example of cross-agency coordination, praising cooperation between the state Medicaid director, the attorney general and the state auditor. He says that approach matters as Ohio ranks fourth nationally for Medicaid expansion and seeks to ensure beneficiaries continue receiving services while state officials work to correct weaknesses.

The exchanges suggest the committee is likely to keep pressing states for records and operational details as it advances its nationwide investigation. For state Medicaid agencies, the review raises compliance pressure around audit readiness, provider verification and the handling of suspected improper claims.

Our earlier article on a Joint Economic Committee hearing examined how waste, fraud and weak oversight are being driven by misaligned payment incentives across Medicare and Medicaid. It highlighted testimony that analytics and AI can improve detection, but deeper structural reforms, stronger data sharing, and tighter congressional controls are needed to reduce persistent inefficiency and rising program costs.

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