Subcommittees

WASHINGTON, D.C. – Today, Congressman John Joyce, M.D. (PA-13), Chairman of the Subcommittee on Oversight and Investigations, led a hearing titled Common Schemes, Real Harm: Examining Fraud in Medicare and Medicaid.

“What’s happening in Minnesota’s Medicaid program is deeply concerning and requires robust Congressional oversight; however, it is just the tip of the iceberg,” said Chairman Joyce. “Medicare and Medicaid fraud has been occurring in communities across the U.S. for decades, diverting necessary resources from patients in need. It is our duty to protect these programs for our most vulnerable Americans.”

Watch the full hearing here.

Below are key excerpts from today's hearing:

Congressman Russ Fulcher (ID-01): “I’m from the state of Idaho—which, sometimes, may not be the first state you think about when there might be fraud, but that is kind of the basis of my question. Have you noticed any trends where states might get targeted or regions might get targeted as a function of potentially them having a lower barrier for entry, or maybe perceived as not being as likely to be audited?” Ms. Gay: “Absolutely. We talk a lot in the industry how [fraud] can be regionally generated. It tends to start in one particular area, and then I don’t know if they’re all hanging out, talking to each other, or how that spreads, but it does tend to start in certain populations and then branch out from there based on controls.” Mr. Fulcher: “What if the bad actor is a foreign actor? How much of that do you see? And if so, what kind of a challenge does that bring to potentially pursuing that fraud, if it’s perpetrated by a foreign actor?” Ms. Wooten: “Certainly, states have seen both fraud cases perpetrated by foreign and by U.S. citizens or people in the U.S., and from our perspective, as being a Medicaid Fraud Control Unit, it makes no difference. We look at allegations, try to identify whether there is something we can do about them? Is the dollar amount something we can pursue? Are we going to be able to get value back for the Medicaid program? Do we have the laws in place to prosecute whatever type of fraud is referred? And we move forward with that investigation.”

Congressman Dan Crenshaw (TX-02): “So what’s the solution here? I mean, some argue stronger oversight would actually threaten access to care, but based on your experience, what actually happens to access when fraud is not controlled? Who bears the brunt of this?” Ms. Gay: “I think there’s certainly the patient-harm attribute you mentioned—you know, not getting the care that you need. […] We dealt with some cases with ACA enrollments, and by the time we verified with CMS that those were eligible recipients, the health plan was already on the hook for $1, $2, $3 million. Were these patients even receiving the care? In some cases, yes. In other cases, they had no idea that they were in a facility for such treatment. […] Now you have somebody that doesn’t even have that challenge, but that is now on their record. And even worse—those that do, that are getting subpar treatment at a very exorbitant rate and still not getting better.”

Congressman Buddy Carter (GA-01): “Auditors found 112 hospice providers operating out of a single physical address. 112...holy cow. As a result, hospice agencies in LA County alone likely overbilled Medicare by $105 million in just one year. […] It looks like it’s a problem in a lot of different places. And that’s why I want to ask you, Ms. Wooten, have you seen instances of copycats where fraudsters see a successful fraud scheme happening in one location, so they try to replicate the same fraud elsewhere?” Ms. Wooten: “Absolutely. We definitely see replicated fraud schemes in hospices; an excellent example. I share your concerns about home health and hospice because I owned a home health agency for many years, and I didn’t even choose to be a hospice because there were specialized agencies that could handle that part, and we would refer to them under the right circumstances. What we now see, though—hospices who are admitting patients who are not terminally ill, patients who don’t know they were put on hospice, patients who maybe aren’t getting treatments that they need, because the hospice philosophy, as you know, is for comfort care, not for treating illnesses. We have seen the same thing in Utah that the hospices have exploded. Now, I’m not saying they’re all fraudulent either, but absolutely; fraudsters learn from fraudsters and it’s an area we have to investigate.”

WASHINGTON, D.C. – Congressman John Joyce, M.D. (PA-13), Chairman of the Subcommittee on Oversight and Investigations, delivered the following opening statement at today’s hearing titled Common Schemes, Real Harm: Examining Fraud in Medicare and Medicaid.

Subcommittee Chairman Joyce’s opening statement as prepared for delivery:

“Good morning, and welcome to today’s hearing entitled ‘Common Schemes, Real Harm: Examining Fraud in Medicare and Medicaid.’

“Recent criminal prosecutions and continued allegations of fraud in the State of Minnesota’s Medicaid and other benefits programs have shone a spotlight on how vulnerable these programs are. Americans are outraged. Any amount of waste, fraud, or abuse of resources and taxpayer funds is too much, but it is particularly alarming when it happens on a scale as large as what is being uncovered in Minnesota.

“What’s happening in Minnesota’s Medicaid program is critical and worth discussing, but it is just the tip of the iceberg — Medicare and Medicaid fraud is common, happening nationwide, and has been egregious for decades.

“Some estimates place annual Medicare and Medicaid fraud losses at $100 billion annually. This is only a conservative estimate because fraud can only be accounted for if it is detected.

“The Government Accountability Office placed Medicare on its inaugural ‘high-risk’ list in 1990, and it has remained there ever since. Medicaid also joined Medicare on the ‘high-risk’ list in 2003. The Department of Health and Human Services Office of Inspector General has also sounded the alarm on the unsustainable rates of waste, fraud, and abuse in Medicare and Medicaid.

“Here are just a few examples of some of the fraud schemes we are seeing in these programs:

“In New York, an adult day care owner defrauded Medicaid over $68 million through illegal patient referral kickbacks and bribery schemes.

“In Arizona, a man based in Pakistan and the United Arab Emirates allegedly billed Arizona Medicaid $650 million in a fraud scheme targeting the homeless and Native Americans seeking substance abuse treatment.

“In another case last year, seven defendants across Arizona and Nevada were charged in connection with an alleged $1.1 billion Medicare fraud scheme for medically unnecessary amniotic wound allografts, or skin substitutes.

“Just a few weeks ago, a Florida laboratory owner pleaded guilty to $52 million in medically unnecessary genetic tests billed on behalf of Medicare beneficiaries.

“In all these cases, patients suffer from unnecessary, inadequate, or a complete lack of medical care. In other cases, patients are unknowingly victims of identity theft or misleading marketing practices perpetrated by fraudsters.

“And as highlighted in one of the above examples, nation-states and overseas criminal gangs are also targeting Medicare and Medicaid. Recent criminal indictments and convictions show the trend is getting worse and exemplify the scale of the fraud. It has been said that health care fraud is becoming easier and more lucrative than the illicit drug trade.

“Patients will suffer if these health care programs cannot continue on a responsible fiscal path. It is our duty to protect these programs for our most vulnerable Americans. American taxpayers invest hundreds of billions into Medicare and Medicaid. We must do better to protect these programs from fraud that is draining them of billions of dollars annually.

“We applaud law enforcement efforts that investigate and prosecute fraud, but we can save more money by detecting and preventing fraud before it occurs, rather than paying and chasing funds after they are paid to criminals.

“I want to thank our witnesses for being here today. Your knowledge about this important topic will help us understand the challenge of Medicare and Medicaid program integrity we are facing today. As our witnesses will testify to today, these are real, legitimate fraud schemes.”

WASHINGTON, D.C. – Today, Congressman Bob Latta (OH-05), Chairman of the Subcommittee on Energy, led a hearing titled Oversight of FERC: Advancing Affordable and Reliable Energy for All Americans.

“Now, as our nation stands at the precipice of substantial change in the global economy, it is imperative for FERC to remain steadfastly focused on their core mission in order to fuel technological advancements and stabilize the bulk power system to keep the lights on,” said Chairman Latta. “Winning the AI race, reshoring manufacturing jobs, and lowering energy costs are not mutually exclusive. When done properly, research continues to show that the growth of large energy users like data centers and manufacturing facilities can help stabilize the grid and make electricity more affordable.

Watch the full hearing here.

Below are key excerpts from today’s hearing:

Congressman August Pfluger (TX-11): “How is FERC working with states that block pipelines? And how are you balancing the affordability mission when you have states like New York that actually kill pipeline projects?” Chairman Swett: “That is a 100-billion-dollar question. Effectively, under the regime that Congress has created, and the Clean Water Act, states have the ability to veto a project if they do not give a certification, and that is a problem that FERC simply cannot work around. If Congress saw fit to change that, we would be happy and ready to implement any directives.” Mr. Pfluger: “Is it your belief that having those pipelines in the capacity to deliver that natural gas lowers prices?” Chairman Swett: “Well, I think as you very wisely stated at the beginning of your comments, the proof is in the pudding. The fact that areas that don’t have enough gas are paying maybe 300 times what they should, as you said, is unacceptable. That is not a just and reasonable rate for Americans.”

Congressman Troy Balderson (OH-12): “When opponents claim that LNG exports raise domestic prices, they ignore the factors that actually increase natural gas costs for consumers, such as the lack of pipeline capacity during the storm. Regions with pipelines to deliver natural gas had significantly lower prices than areas with constrained capacity. In fact, on January 26, 2026, the Monday after Winter Storm Fern, Northeast winter gas prices were up 2.4 times higher than the Appalachia supply. FERC has taken important actions to address constrained pipeline capacity, like repealing Order 871 and examining cost thresholds for blanket approvals. Can you discuss what other action FERC is considering taking to expedite the construction of needed energy infrastructure projects? And how will these actions help deliver affordable, reliable energy to our constituents?” Chairman Swett: “Thank you for the question. I also am very concerned about Northeast prices, and one thing that was really shocking for me coming out of the storm was that, in the Northeast during Fern, 40 percent of generation came from fuel oil or diesel, and that’s simply because we don’t have enough gas infrastructure to bring gas to New England. So, I fully agree with you. That’s why we are looking to, wholesale across the board, take a hard look at our permitting actions. And when it comes to pipelines in particular, we are trying to streamline our NEPA process.”

Congressman Russell Fry (SC-07): “Chairman Swett, the Seven County [Infrastructure Coalition v. Eagle County] Supreme Court decision was remarkable in a way, because it was won unanimously. So, in a body like ours that oftentimes has several different ways to view any particular issue, when you see a unanimous Supreme Court decision, it kind of raises your eyebrows a little bit. The Court held that courts should—afford substantial deference to an agency as to the scope and contents of an environmental impact statement. How has FERC changed its NEPA practice in response to the Seven County decision? And to piggyback on top of that, what is left to do to come in line with that decision?” Chairman Swett: “Thankfully, the Seven County decision allowed FERC, in my opinion, to realign our emissions analyses with our statutory responsibility as a primarily economic regulator charged with encouraging the development and plentiful supply of natural gas at reasonable prices, per Congress’s instruction. So, what that means, when the rubber hits the road, is now we no longer analyze the indirect emissions from upstream production or downstream combustion.”