Health

WASHINGTON, D.C. - Last December, the Department of Health and Human Services (HHS) Office of Inspector General (OIG) released a report showing that since 2016, OIG has conducted 18 audits, which revealed Medicaid agencies improperly paid states nearly $289 million on behalf of deceased enrollees. The audit outlined in HHS OIG’s report was conducted from July 1, 2021, through June 30, 2022. After reviewing a stratified random sample of 100 capitation payments from the nearly 410,000 capitation payments covered by the audit, HHS OIG found that Medicaid agencies paid for deceased individuals in 99 of the 100 sample capitation payments. During that same one-year period, Medicaid paid over $207 million to insurance companies for people who had already died. This is far from the first accounting of massive fraud found in our federal health programs. In July of 2025, the Centers for Medicare & Medicaid (CMS) announced that they had identified and were removing 2.8 million duplicative enrollees in two or more Medicaid and/or Affordable Care Act (ACA) exchange plans after conducting an analysis of 2024 enrollment data. In September of 2025, the Congressional Budget Office (CBO) found that Democrat policies have facilitated a years-long, massive cover-up to defraud American taxpayers in order to subsidize waste, fraud, and abuse in federal health programs, including using loopholes to provide free health care to illegal immigrants. The agency found that Democrat policies have led to at least 2.3 million fraudulent enrollees in Obamacare. And most recently, in December, GAO conducted covert operations by creating fictitious identities with fake or never issued Social Security numbers (SSN) and still received taxpayer-subsidized Obamacare coverage. One hundred percent of fake applicants were approved by the ACA Marketplace in late 2024 and 90 percent of fake applicants received coverage in 2025. Experts estimate the federal government may be spending as much as $27 billion a year in taxpayer dollars on improper Obamacare enrollments. Thanks to President Trump’s Working Families Tax Cuts signed into law on Independence Day last year, Republicans implemented commonsense guardrails to protect Americans and crack down on the Democrat-enabled waste, fraud, and abuse pervading our health care system. Our law takes action to remove duplicative and deceased enrollees from the Medicaid rolls and prohibit states from paying multiple managed care organizations for wasteful, duplicative health care coverage. We believe that taxpayer dollars should be used to benefit our most vulnerable Americans. To that end, the Committee has sent letters to state and federal officials requesting additional information on Medicare and Medicaid fraud. For example, the Committee opened an investigation into the massive fraud schemes in Minnesota's Medicaid programs; and just last week, our Subcommittee on Oversight and Investigations held a hearing exploring the egregious Medicare and Medicaid fraud schemes that are happening nationwide. Over the past several years, Democrat Administrations have allowed waste, fraud, and abuse across the American health care system to explode, ultimately driving up costs, hurting American families, and draining taxpayer dollars. Republicans are committed to finding solutions that restore affordability, fairness, accountability, and the rule of law across our health care system. Read the full report here .

WASHINGTON, D.C. – Today, Congressman Morgan Griffith (VA-09), Chairman of the Subcommittee on Health, led a hearing titled Lowering Health Care Costs for All Americans: An Examination of the Prescription Drug Supply Chain, featuring witness testimony from representatives across the entire prescription drug supply chain.

“I’m proud of this subcommittee’s work, but there is still more to be done—which is why I was proud to continue building on our affordability series through today’s hearing with representatives across the entire prescription drug supply chain,” said Chairman Griffith. “Hearing from these witnesses on how to best navigate this complex web helps Congress make better-informed policy decisions so that we are able to meaningfully lower the cost of care for all American patients.”

Watch the full hearing here:

Below are key excerpts from today’s hearing:

Congressman Troy Balderson (OH-12): “I represent a very rural district, and not only is access to health care a problem, but access to pharmacy services is growing more challenging as well. A 2025 FTC report examined PBM pharmacy contracting practices and found that internal PBM documents suggested rural pharmacies are often forced to accept ‘take it or leave it’ reimbursement rates. Could you elaborate on the specific challenges rural pharmacies face when negotiating contracts with PBMs, and how these practices may affect access to care in rural communities?” Mr. Hoey: “‘Take it or leave it’ contracts are part and parcel of the so-called negotiations between pharmacies and PBMs. PBMs hold all the leverage. They hold the patient lives. So, if a pharmacy does not sign whatever is put in front of them—with very little negotiation—I’m sure our friends at PMA will say there’s robust negotiation, but in reality, it’s a take-it-or-leave-it contract. These pharmacies are often forced to sign contracts that pay them below their cost to acquire the drug. And yes, rural pharmacies, as well as pharmacies in underserved areas, urban areas, and suburban communities, are all taking contracts in which they are paid below cost. As a result, 5,000 pharmacies have gone out of business in the last four years alone. That’s 5,000 fewer pharmacy choices in just four years. It’s a systemic problem. In fact, pharmacy deserts—especially in your district in Ohio and across the country—are growing because of these ‘take it or leave it’ contracts.”

Congresswoman Kat Cammack (FL-03): “Three companies control the majority of drug distribution in the United States, and many are vertically integrated to control each phase of the prescription drug supply chain—from manufacturer to pharmacy. Does consolidating the prescription drug industry lower prices for patients? Yes or no?” Mr. Davis: “It has the potential to, yes.” Congresswoman Kat Cammack: “Respectfully, your own industry report projects that the ‘big three’ will generate $871 billion in revenue this year—after four straight years of double-digit growth. So, if this is potentially saving patients money, why are revenues growing so fast, and where are patients seeing the savings?”

Congressman Michael Rulli (OH-06): “President Trump recently launched TrumpRx, a revolutionary platform aimed at bringing price transparency and competition back to the drug market. My constituents tell me every day about how much they dread going to the pharmacy because they never know what price they’re going to pay at the counter; it always changes. Then, you have brand-name versus [generic]... How have your members reacted to the transparent pricing of brand-name [drugs] on TrumpRx?” Mr. Marin: “The PBM industry is all about transparency. We are enhancing it for our customers every day, particularly for employers. The bill Congress passed a couple of weeks ago takes [transparency] to another level—we’re happy with that. We support and applaud the mission of the administration’s goal with TrumpRx.”

WASHINGTON, D.C. – Congressman Morgan Griffith (VA-09), Chairman of the Subcommittee on Health, delivered the following opening statement at today’s hearing titled Lowering Health Care Costs for All Americans: An Examination of the Prescription Drug Supply Chain.

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

“First, I want to recognize the bipartisan bill that we were able to pass last week that included many important health care provisions and lowered health care costs for all Americans.

“Today, we will discuss health care costs and patient access challenges by examining affordability across the entire pharmaceutical supply chain.

“I’m proud of this subcommittee’s work, but there is still more to be done, which is why I am eager to continue building on our affordability series with today’s hearing that comes after we heard from insurance executives last month.

“We now will hear from stakeholders who are part of the complex pharmaceutical drug supply chain.

“To regular people, this system may seem simple: a disease is researched and a treatment is developed, then that treatment is manufactured and distributed to a hospital, pharmacy, or other health entity before it is dispensed to a patient.

“However, there are many more layers that are involved in this process that affect how a drug gets to a patient and how that drug is priced.

“One of the most frustrating aspects of the supply chain is that it operates in a blackbox.

“Luckily, we have witnesses here to provide their perspectives and shine a light on the process.

“Do each of these entities in front of us today play a role in getting the drug to a patient? Yes.

“Are there too many cooks in the kitchen at times? Probably so.

“Today is a great opportunity for Congress to get a glimpse and see what is happening, and look for ways to help make prescription drugs more affordable.

“In 2017, this same subcommittee held a hearing similar to this one.

“A lot has changed since then.

“I am glad we are reexamining what we learned from that hearing to continue working towards what we all want: lowering costs for patients while ensuring that America remains a leader in pharmaceutical innovation.

“We have PhRMA and BIO in front of us who can speak to the intricacies that go into researching, developing, and pricing a drug on the market.

“We will also get the perspective of generic drugs from the Association for Accessible Medicines who can speak on the issues in that area.

“We also have the Pharmaceutical Care Management Association here who is the trade association that represents pharmaceutical benefit managers, or PBMs.

“In theory, PBMs manage prescription drug benefits for insurance companies, employers, and others.

“What we heard in our hearing last month is that insurance companies own many PBMs.

“The largest three insurance owned PBMs control over 80 percent of the market.

“How they manage these benefits is a mystery and can lead to higher drug prices.

“However, just last week, led by Representative Buddy Carter from Georgia, Congress passed and the President signed into law the biggest PBM reform package in history.

“These bills will bring more transparency into this system, lower costs, and allow for more access to medicines.

“The Healthcare Supply Chain Association is here on behalf of Group Purchasing Organizations, or GPOs, which act as intermediaries between manufacturers and providers.

“In front of us is also the Healthcare Distribution Alliance, who is involved in the distribution of prescription drugs along the supply chain.

“I am looking forward to hearing from the National Community Pharmacists Association who is before us today as well, since they represent community pharmacists.

“These community pharmacies serve a critical role in bringing care to patients, especially in rural areas; yet, many have had to sadly close their doors in recent years due to factors we will discuss today.

“The ERISA Industry Committee is also here to discuss their point of view for employers when it comes to high costs, as well as decisions they make based on those costs.

“Each of these different entities play a unique role in how a drug finally gets to a patient.

“In this meeting, we will hear from these witnesses on how to navigate this complex web on behalf of the American people.

“I look forward to the discussion.”

WASHINGTON, D.C. – Congressman Brett Guthrie (KY-02), Chairman of the House Committee on Energy and Commerce, Congressman John Joyce, M.D. (PA-13), Chairman of the Energy and Commerce Subcommittee on Oversight and Investigations, Congressman Morgan Griffith (VA-09), Chairman of the Energy and Commerce Subcommittee on Health, Congressman Jason Smith (MO-08), Chairman of the House Committee on Ways and Means, Congressman David Schweikert (AZ-01), Chairman of the Ways and Means Subcommittee on Oversight, and Congressman Vern Buchanan (FL-16), Chairman of the Ways and Means Subcommittee on Health, authored ** a letter ** to the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) requesting a meeting on the concerning evidence detailed in the letter that points to large-scale, ongoing Medicare fraud in Los Angeles County, along with what action is being taken to address the situation.

“The House Committee on Energy and Commerce has an extensive history of digging deeper into matters where program integrity has been compromised. This letter is crucial in our commitment to eliminating waste, fraud, and abuse in federal health care programs,” said Chairmen Guthrie, Joyce, and Griffith. “Republicans have spent much of this Congress furthering legislation to protect our most vulnerable Americans—especially seniors, but our work is not done. Continued oversight is crucial to uphold the integrity of programs that serve our most vulnerable populations. We applaud the ongoing work being conducted by HHS-OIG in cracking down on the fraud that has occurred, and we look forward to addressing the larger-scale scheme that is draining public resources from Americans who need these services the most.”

“Medicare home health and hospice fraud directly undermines the safety and reliability of care for America’s most vulnerable seniors. Auditors have reported an unprecedented jump in home health and hospice fraud in Los Angeles County, California – including one report showing 112 different hospices located at the same physical address. With $1.2 billion in improper payments in home health claims and the Inspector General reporting $198 million in suspected hospice fraud, Gavin Newsom’s California could just as well be another Minnesota,” said Chairman Smith. “The Ways and Means Committee will not hesitate to use our broad oversight authority to get to the bottom of this and protect taxpayers and vulnerable patients against these bad actors.”

BACKGROUND:

Evidence has strongly suggested large-scale Medicare fraud involving home health agencies (HHA) and hospice agencies in Los Angeles County, California, noting that such practices not only drain public resources but also compromise the quality of care provided to patients, especially those most vulnerable populations.

• The Centers for Medicare and Medicaid Services (CMS) found that the 2023 improper payment error rate for home health claims was 7.7 percent, or about $1.2 billion, in 2023.
• In terms of hospice care, HHS OIG reported suspected hospice fraud to be an estimated $198.1 million in fiscal year (FY) 2023.
• CMS has placed HHAs as an area of high risk for Medicare fraud.

Emerging concerns over Medicare fraud in the HHAs and hospice sector highlights heightened activity, specifically in Los Angeles County.

• From 2019 through June 2023, HHAs in the U.S. decreased from 8,838 to 8,280 (6 percent), while, at the same time, HHAs in Los Angeles County increased from 896 to 1,309 (46 percent).
• More than 1,400 new Los Angeles County HHAs enrolled in Medicare in the last five years, representing over 50 percent of all HHAs in the state of California and nearly 14 percent of all HHAs in the country.

Based on data from the March 2022 California State Auditor’s Report and from HHS on hospice ownership, Los Angeles County had more than 31 percent of the hospice agencies in the U.S. in 2022.

• There were approximately 58 million seniors in the U.S. in 2022, with Los Angeles County having approximately 1.49 million seniors (2.5 percent).
• The report highlighted indicators that included a “rapid, disproportionate growth in the number of hospice agencies” and “excessive geographic clustering of hospice agencies,” noting that 112 different licensed hospice agencies were located at the same physical address.
• State auditors in California estimated that hospice agencies in Los Angeles County likely overbilled Medicare by $105 million in 2019.

These accounts of widespread fraud occurring in Los Angeles County’s HHAs and hospice agencies have raised concerns about whether home health and hospice Accrediting Organizations (AO) are effectively examining such organizations at the time of their enrollment in Medicare.

• In November 2024, CMS issued a Quality, Safety, and Oversight memo to surveyors, reminding them to closely inspect hospices’ Medicare enrollment documents to understand changes in ownership and location, but neglecting to encourage AOs to pursue other commonsense antifraud measures.

In April 2025, HHS OIG announced that the Office of Audit Services would compile a report for FY 2026 to identify trends, patterns, and comparisons that could indicate potential vulnerabilities related to new Medicare hospice provider enrollments.

In May 2025, the Health Care Fraud Strike Force—a joint task force of federal, state, and local law enforcement agencies, including HHS OIG—** announced multiple arrests ** following a multi-year investigation into Armenian Organized Crime, which dismantled five hospices in the greater Los Angeles area.

On November 28, 2025, CMS ** announced ** the Calendar Year 2026 Home Health Prospective Payment System Final Rule, providing comments that suggest an interest in addressing the aforementioned accounts of fraud.

WASHINGTON, D.C.  – House Committee on Energy and Commerce Chairman Brett Guthrie (KY-02) and Ranking Member Frank Pallone Jr., (NJ-06), along with Energy and Commerce Subcommittee on Oversight and Investigations Chairman John Joyce, MD (PA-13), and Ranking Member Yvette D. Clarke (NY-09), wrote to the Health Resources and Services Administration (HRSA) requesting a briefing on its ongoing oversight of patient safety in our nation’s organ procurement and transplant system.   In July, the Committee’s Oversight and Investigations Subcommittee held a hearing in response to a HRSA investigative report that found patient safety concerns at Kentucky Organ Donor Affiliates (KYDA) – the organ procurement organization (OPO) serving the state of Kentucky. In the investigative report, HRSA revealed that of the 351 cases reviewed, 103 cases (29.3 percent) showed “concerning features.” These concerning features included problems with patient-family interactions, medical assessments and team interactions, recognition of high neurologic function, and recognition and documentation of drugs in records.   In addition, HRSA issued a corrective action plan to address the findings in its report specific to KYDA and directing the Organ Procurement and Transplantation Network (OPTN) Board of Directors to develop certain safety guidelines for the entire OPTN. The corrective action plan raised further questions about the possibility that there may be more systemic issues at OPOs across the country, noting that “ [s]ince the review of KYDA was initiated, HRSA has received reports of similar patterns of high risk [donation after circulatory death] procurement practices at other OPOs .” Moreover, during the July hearing, HRSA’s Organ Transplant Branch Chief, Dr. Raymond Lynch was questioned about the potential failure to adhere to existing protocols by Rep. Erin Houchin (IN-09): “ is it a broader systemic issue or is it limited to KYDA ?” Dr. Lynch responded that “ [u]nfortunately, it is not limited to KYDA. During the course of this investigation we received concerns that were in areas served by other OPOs. ”  Chairmen Guthrie and Joyce and Ranking Members Pallone and Clarke issued the following joint statement:    “ The Committee’s examination of the organ procurement and transplant system has demonstrated the need for further oversight.  Testimony from the July hearing, HRSA’s investigative report and corrective action plan, and continued reports of similar patterns at other OPOs all raise serious concerns. The American people should be able to have full faith and confidence in our organ donor and transplant system, and we will continue to work together to prevent these harmful practices from continuing. Americans’ confidence in the system comes when patient safety is protected. ”    Read the full letter  here . Background:  ·       During the 118th Congress, the Committee on Energy and Commerce  passed  the Securing the U.S. Organ Procurement and Transplantation Network Act to both modernize the OPTN and allow HRSA to institute a competitive contracting process to find the best contractors for various OPTN functions. This legislation was signed into law on September 22, 2023.   ·       On March 20, 2024, the Committee  launched an investigation  into the organ procurement and transplantation system by sending  a letter  to United Network for Organ Sharing (UNOS) requesting information related to concerns surrounding data security and operability, patient safety and equity, and conflicts of interest.    ·       On March 20, 2024, the Committee also sent  a letter  to HRSA requesting information related to implementation of the Securing the U.S. Organ Procurement and Transplantation Network Act as well as other concerns related to effective oversight and management.   ·       On September 11, 2024, the Subcommittee on Oversight and Investigations held a  hearing  that focused on the implementation of reforms at the OPTN, including the need for stronger oversight and accountability as well as ongoing patient safety concerns.   ·       During the hearing, questions were raised related to allegations of mismanagement and patient safety concerns after patients began exhibiting signs of increased neurologic function after being previously deemed suitable as an organ donation candidate. Several of these allegations, particularly those related to patient safety, were later substantiated through the findings contained in HRSA’s March 2025 report.   ·       On March 24, 2025, HRSA’s Division of Transplantation issued a  report  that summarized the findings of its investigation into KYDA, the OPO now known as Network for Hope, which serves Kentucky and parts of Ohio, West Virgina, and Indiana.  ·       On May 28, 2025, HRSA issued a  CAP  to OPTN, which directed the OTPN to take specific actions within a specified period of time, including developing a 12-month OPTN monitoring plan for KYDA to address concerns identified. The corrective action plan also requires the OPTN to propose policies for public comment to improve safeguards for potential donation after circulatory death (DCD) patients in the organ procurement process and increase information shared with patient families regarding DCD organ procurement.   ·       On July 22, 2025, the House Committee on Energy and Commerce’s Subcommittee on Oversight and Investigations held a  hearing  examining concerning practices within our nation’s organ procurement and transplant system that were identified by HRSA’s investigation.   ###

WASHINGTON, D.C. – Congressman Brett Guthrie (KY-02), Chairman of the House Committee on Energy and Commerce, along with Reps. Palmer (AL-06), Carter (GA-01), Bilirakis (FL-12), and Obernolte (CA-23), penned a letter to the Executive Director of Covered California (CoveredCA), Jessica Altman, to request further information related to the potentially unauthorized transmission of sensitive personal health information involving Covered California’s website. Key Letter Excerpt: “According to public reports and agency statements, tracking technology was embedded on Covered California's website beginning in February 2024, as part of a broader digital advertising effort, and in direct contravention of the tracking platform’s user agreement, which prohibits the use of such tools on pages that collect sensitive health information. Although the tags were reportedly removed in April 2025, following external scrutiny and a vendor transition, the extended period of data exposure raises serious questions about the adequacy of safeguards that Covered California had in place. Forensic testing by investigative reporters identified the trackers in operation and confirmed that user-entered health information was being transmitted to third parties without consent. These circumstances warrant examination of Covered California’s actions under federal privacy standards.” “Ensuring the confidentiality of health information is a foundational obligation for entities operating within the health insurance ecosystem. Federal privacy protections, particularly the Health Insurance Portability and Accountability Act (HIPAA), establish expectations for how covered organizations handle sensitive data. Recent reports and public filings raised questions about whether those expectations were met in this case, and whether existing oversight mechanisms are sufficient to detect and prevent improper disclosures.” Background: Forensic testing shows Covered California —the State of California’s official health insurance marketplace—has been sending sensitive user health data to third-party websites through several online data trackers. Prior to removal of the trackers, CoveredCA had more than 60 trackers active on its website; the average number of trackers on a government website is three. Some types of information sent to such websites include: Searches for doctors in network with specific plans/specializations Demographic information, including gender, ethnicity, and marital status Length of treatment a patent received by a provider Frequency of doctor visits If the user indicated they were blind, pregnant, a victim of domestic abuse, or used prescription medications. The State of California independently operates CoveredCA. As the state’s official ACA marketplace, CoveredCA falls under the purview of Health Insurance Portability and Accountability Act (HIPAA). The disclosure of information such as pregnancy or prescription drug use without proper consent—even for “marketing purposes”—may violate HIPAA. This Congress, the Committee has sent letters to 23andMe and DeepSeek over potential data privacy concerns: The Committee also held a hearing last Congress on the Change Healthcare hack, where personal health information was also jeopardized. CLICK HERE to read Fox News coverage of the letter. CLICK HERE to view the full letter. ###