House Energy & Commerce Committee Probes Medicare and Medicaid Fraud in Provider Hearings

Republican leaders on the House Energy & Commerce Committee expanded their Medicaid fraud investigation on March 5, 2026, by sending letters to governors and state officials in 10 states, including California and New York. The move aims to assess state actions on Medicaid program integrity amid ongoing concerns about waste, fraud and abuse costing billions annually, officials said.

The letters sent on March 5 targeted governors and state officials in California, Colorado, Massachusetts, Maine, Nebraska, New York, Oregon, Pennsylvania, Vermont, and Washington, according to a joint statement from House Energy & Commerce Committee Chairmen Brett Guthrie (R-Ky.), John Joyce (R-Pa.), and Morgan Griffith (R-Va.). The expansion aims to evaluate state efforts to maintain Medicaid program integrity amid ongoing concerns about waste, fraud and abuse, which officials say cost the program billions of dollars annually.

Officials also cited a notable example involving 5,029 skin substitute claims filed for an 89-year-old hospice patient, which CMS Deputy Administrator Kimberly Brandt described during a March 17 hearing as a clear indicator of fraud.

Chairman Griffith emphasized the committee’s commitment to investigating fraud within Medicaid, stating, “Republicans in Congress will continue to do the necessary legwork to investigate allegations of waste, fraud and abuse within our Medicaid system.” Guthrie and Joyce noted the letters followed an earlier hearing held by the Subcommittee on Oversight and Investigations on February 3, 2026, titled “Common Schemes, Real Harm: Examining Fraud in Medicare and Medicaid.” The hearing featured expert testimony on prevalent Medicaid fraud schemes and the nationwide scale of abuse, with discussions highlighting programs particularly vulnerable to exploitation.

The February hearing, held at the Rayburn House Office Building, included testimony about cases such as one in Arizona involving international billing schemes allegedly operated from Pakistan and the United Arab Emirates, according to committee records and a video of the hearing available on YouTube. Brandt testified that such extreme claims would be “mummified” if legitimate, underscoring the severity of the issue.

On March 17, the Subcommittee held another hearing titled “Protecting Patients and Safeguarding Taxpayer Dollars: The Role of CMS in Combatting Medicare and Medicaid Fraud.” Chairmen Guthrie and Joyce announced the hearing as part of ongoing investigations into Medicare and Medicaid fraud. Joyce stated, “Taxpayers are being defrauded of outrageously large amounts of money,” while Brandt detailed CMS’s shift from a “pay-and-chase” approach to front-end fraud prevention, utilizing machine learning to identify suspicious claims in real time.

CMS officials highlighted recent actions taken in February 2026, including deferring over $259 million in federal Medicaid funding to Minnesota for fourth-quarter fiscal year 2025 claims, as part of efforts to mitigate fraud. The agency also reported stopping $1.8 billion in improper payments last year, with more than $100 million linked to laboratory services fraud. The Trump administration previously launched Medicaid program integrity inquiries in California, New York, and Maine, according to CMS statements and committee documents.

Committee members pointed to specific fraud cases to illustrate the scope of the problem. In Oregon, a woman was sentenced to federal prison for submitting fraudulent Medicaid claims using stolen identities. Laboratory services fraud and schemes involving skin substitutes were repeatedly cited as significant contributors to Medicaid losses nationwide. Officials stressed that these fraudulent activities divert funds from quality care and increase health care costs for beneficiaries and taxpayers alike.

Chairman Joyce criticized state oversight, stating, “For too long, states have been permitted to run Medicaid programs with weak guardrails, making them easy targets for criminals.” The committee’s expanded investigation seeks to hold states accountable for stewarding taxpayer dollars responsibly while ensuring Medicaid programs serve their intended populations. Rep. Griffith added, “Americans support federal health care programs that serve American communities, not fraudsters!”

While members agreed on the seriousness of Medicaid fraud, some debate persisted over the political motivations behind the oversight efforts. Nonetheless, CMS officials underscored the necessity of federal involvement, citing the agency’s enhanced fraud detection capabilities and the importance of proactive prevention measures.

The committee’s ongoing probe follows a pattern of hearings and inquiries aimed at uncovering and addressing systemic vulnerabilities in Medicare and Medicaid programs. Future steps are expected to include continued oversight, additional state inquiries, and potential legislative measures to strengthen program integrity and protect taxpayer funds, according to committee sources.