Oversight & Investigations

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. – This week, the House Committee on Energy and Commerce is holding three Subcommittee Hearings and one Subcommittee Markup. Read more below.

SUBCOMMITTEE HEARING: The Energy and Commerce Subcommittee on Energy is holding a hearing to discuss oversight of FERC.

• DATE: Tuesday, February 3, 2026
• TIME: 10:15 AM ET
• LOCATION: 2123 Rayburn House Office Building

SUBCOMMITTEE HEARING: The Energy and Commerce Subcommittee on Oversight and Investigations is holding a hearing on how fraudsters are draining state and federal governments through schemes in our government-run health programs.

• DATE: Tuesday, February 3, 2026
• TIME: 10:30 AM ET
• LOCATION: 2360 Rayburn House Office Building

SUBCOMMITTEE HEARING: The Energy and Commerce Subcommittee on Communications and Technology is holding a legislative hearing on FirstNet reauthorization.

• DATE: Wednesday, February 4, 2026
• TIME: 10:15 AM ET
• LOCATION: 2123 Rayburn House Office Building

SUBCOMMITTEE MARKUP: The Energy and Commerce Subcommittee on Energy will hold a markup of five bills.

• DATE: Wednesday, February 4, 2026
• TIME: 2:00 PM ET
• LOCATION: 2123 Rayburn House Office Building

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, and Congressman Morgan Griffith (VA-09), Chairman of the Energy and Commerce Subcommittee on Health, are requesting communications, documents, and information from Minnesota Governor Tim Walz and the Temporary Commissioner of Minnesota’s Department of Human Services, Shireen Gandhi, to better understand the ongoing Medicaid fraud occurring in the state of Minnesota and actions the state is taking to strengthen program integrity.

The unprecedented fraud scheme in Minnesota, which has potentially been ** ongoing ** since 2013, has revealed a swath of criminal schemes, including overbilling, false records, identity theft, and phantom claims in Medicaid social service and health programs for the elderly and disabled, people struggling with addiction, and homelessness. Chairmen Guthrie, Joyce, and Griffith issued the following statement regarding ** the letter’s ** content:

“The extensive fraud schemes being perpetrated in Minnesota have wreaked havoc on government-funded health programs. We have an obligation to ensure finite taxpayer dollars are being used responsibly, and that the most vulnerable Americans are not being exploited to the benefit of fraudsters and foreign actors,” said Chairmen Guthrie, Joyce, and Griffith. “As members of Congress and this Committee, our track record has made our continued commitment to ridding government programs of waste, fraud, mismanagement, and abuse clear. This letter is the next step in the Committee’s work to root out fraud and restore program integrity in our federal health programs nationwide.”

The Trump Administration has taken concrete steps to address the fraud being uncovered in Minnesota. Complementary to that work, Congress has a responsibility to oversee federal programs, like Medicaid, to ensure precious dollars and resources are being spent appropriately to deliver quality and necessary care.

BACKGROUND:

Glaring accounts of waste, fraud, and abuse in Minnesota’s Medicaid social service and health programs have resulted in billions of taxpayer dollars going straight to the pockets of fraudsters and foreign actors.

• Ongoing investigations indicate that fraudulent provider schemes are particularly prevalent in health and community-based service programs, including residential drug and alcohol treatment, home health, housing, and autism service programs.

Unfortunately, Minnesota’s Medicaid program lacks adequate oversight and fraud control measures, and state officials have neglected to swiftly identify and address vulnerabilities in programs.

• Fraud experts note that fraudsters often target states like Minnesota, which tend to have the “weakest ID checks, fastest payouts, and lowest audit risk,” when looking to establish fraud schemes.

In July 2025, the Working Families Tax Cuts legislation was signed into law by President Trump, including critical provisions to target waste, fraud, and abuse within the Medicaid program—several of which help prevent the fraud schemes that occurred in Minnesota from happening again.

In response to these fraudulent practices, CMS is auditing the Minnesota Medicaid program, freezing provider enrollment, and deferring payments for 14 high-risk programs, including adult companion, rehabilitative mental health services, individualized home supports, residential treatment services, among others—which, alone, cost taxpayers $3.75 billion annually.

CMS recently briefed the Committee on what is currently known about the Medicaid fraud in Minnesota and actions CMS has taken to date. This further underscored the need for the Committee’s oversight to ensure program integrity.

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. – Today, Congressman Brett Guthrie (KY-02), Chairman of the House Committee on Energy and Commerce, Congressman John Joyce, M.D. (PA-13), Chairman of the Subcommittee on Oversight and Investigations, and Congressman Gary Palmer (AL-06), Chairman of the Subcommittee on Environment, sent a letter to Steven S. Cliff, Ph.D., Executive Officer of the California Air Resources Board (CARB), demanding answers and documents that the Committee previously requested from CARB on California’s refusal to follow the law and implement the Clean Air Act as written by Congress. The Committee also requested transcribed interviews of six individuals if CARB fails to provide the previously requested information by December 5, 2025.    “The Committee’s August 11, 2025, letter requested information and documents from the California Air Resources Board (CARB) about California’s enforcement of state vehicle emission standards that disregard recent Congressional actions to disapprove waivers of federal preemption under the Clean Air Act,” said Chairmen Guthrie, Joyce, and Palmer. “Unfortunately, CARB’s responses to date have been woefully inadequate and do not satisfy the Committee’s important oversight interests in this matter.” Key excerpt from the letter: “Clean Air Act section 209(a) preempts states from adopting or attempting to enforce any emissions control standard for new motor vehicles or engines, or any condition precedent to the initial retail sale, registration or inspection of such vehicle or engine. Under section 209(b), the U.S. Environmental Protection Agency (EPA) may waive federal preemption, allowing California to establish state motor vehicle emission standards. However, Congress passed with bipartisan support, and President Trump signed, three resolutions under the Congressional Review Act (CRA) disapproving three waivers of preemption that the Biden-Harris Administration previously granted.” “Due to CARB’s failure to make a good faith effort to provide the requested information and documents, the Committee requests transcribed interviews with the following individuals if CARB fails to provide the requested information and documents by December 5, 2025: Lauren Sanchez, CARB Chair (from September 2025 to present); Liane Randolph, Former CARB Chair (from December 2021 to September 2025); Steven Cliff, CARB Executive Officer; Shannon Dilley, CARB Chief Counsel; Christopher Grundler, CARB Deputy Executive Officer – Mobile Sources & Incentives; and Robin Lang, Division Chief, CARB Emissions Certification & Compliance Division. “The Committee requests that these transcribed interviews be completed no later than December 12, 2025.” Background: Since President Trump signed the three Congressional Review Act resolutions into law, revoking California’s ability to set state emission standards that mandate the sale of EVs, the state cannot move forward with plans to ban the sale of gas-powered vehicles. The Committee’s August 11, 2025, request sought answers about California’s apparent enforcement of the preempted standards and requested copies of related documents, such as internal guidance CARB provided to its staff, communications with other states, internal correspondence between CARB officials and the Governor’s Office and the Office of Attorney General, and other internal documents concerning CARB’s response to the disapproval of the waivers of federal preemption. The requested information and documents will help the Committee understand how California is implementing the Clean Air Act in light of the federal preemption of state emission standards, and whether the waiver authority in Clean Air Act section 209(b) should be eliminated or otherwise modified. CLICK HERE to read the full letter .