Guthrie: “If you’re cheating the system, we’re going to come after you. If you’re the most vulnerable, you’re going to be taken care of.”
WASHINGTON, D.C. - Yesterday, Congressman Brett Guthrie (KY-02), Chairman of the House Committee on Energy and Commerce, and Congressman John Joyce, M.D. (PA-13), Chairman of the Subcommittee on Oversight and Investigations, continued their fight against fraud in Medicaid programs across the country... while Democrats used our most vulnerable Americans as a political football denying that evidence of widespread Medicaid fraud exists and claiming that Republicans' efforts to combat Medicaid fraud are merely a political exercise.
Even after three hearings held in the Energy and Commerce Committee's Subcommittee on Oversight and Investigations, Democrats still refuse to acknowledge that fraud schemes occurring nationwide within government health programs are real, plentiful, destructive, and in some cases, even lethal.
In January 2026, two individuals pleaded guilty to a seven-year $68 million Medicaid fraud scheme involving two Brooklyn-based social adult daycares (SADC) and a home health company.
On February 19, 2026, the New York State Comptroller "found questionable Medicaid payments, safety risks, and compliance problems" in SADC programs. In another instance, two Queens men who owned SADCs and a pharmacy were charged with $120 million in alleged Medicare and Medicaid fraud schemes.
On April 7, 2026, a California man pleaded guilty to submitting nearly $270 million in fraudulent claims over an 11-month span to California's Medi-Cal program for expensive prescription drugs that were medically unnecessary and, in many instances, not provided to the purported recipients.
In May 2026, then-Ohio Attorney General Dave Yost announced that three individuals had been charged with fabricating home health billing time sheets, billing for services that were not provided, and double billing while working at other jobs. Two of the individuals even billed Medicaid for in-home health services that were not possible-one while a client was hospitalized for four months, and another when the provider was on vacation in Jamaica.
On May 13, 2026, Vice President J.D. Vance announced a deferral of $1.3 billion in questionable or potentially unallowable costs in California's Medi-Cal program, specifying that, "the state of California has not taken fraud very seriously."
On May 21, 2026, the DOJ announced the Minnesota Health Care Fraud Takedown-the largest Medicaid fraud take down in the history of the District of Minnesota-where two individuals perpetrated a $46.6 million scheme to bill for Early Intensive Developmental and Behavioral Intervention services for children with autism that were not necessary or never provided. The defendants allegedly paid kickbacks to parents to enroll their children in autism therapy, facilitated diagnosing children with autism whether or not they in fact had the condition, and billed Minnesota Medicaid for services that were not rendered.
On June 4, 2026, DOJ announced a $30 million Medicaid fraud case, known as "Operation Playground Therapy," where the defendants operated behavioral health services companies that submitted false claims for therapy services for children and young adults. In the course of its investigation, DOJ "seized three bank accounts with $469K in funds and 14 vehicles worth $800K."
In June 2026, a New York $38 million SADC Medicaid scheme involving kickbacks and false billing resulted in the arrest of eight individuals.
DOJ, just a few days ago, announced the 2026 National Health Care Fraud Takedown, which resulted in charges against 455 defendants, including 90 doctors and other licensed medical professionals, for their alleged participation in health care fraud and opioid abuse schemes involving over $6.5 billion in false claims and significant patient harm, including death. Why are Democrats continuing to deny that vulnerable Americans are being harmed by bad actors exploiting critical safety net programs?
There are endless examples of fraud plaguing Medicaid, and billions of taxpayer dollars are lining the pockets of bad actors who are exploiting critical programs. And worst of all, vulnerable Americans are kept from receiving critical and potentially life-saving care. Yet, instead of facing the facts, Democrats continued to double down on their fearmongering tactics. Because unlike Democrats, Republicans believe that fraudsters who use precious taxpayer dollars to buy luxury cars and designer jewelry deserve to be put behind bars.
Republicans make no apologies for working to restore the integrity of a program intended to protect America's most vulnerable: expectant mothers, children, low-income seniors, and individuals living with disabilities. And we will not stop until vulnerable Americans are safeguarded and the Medicaid program and the taxpayer dollars that fund it are used for their intended purpose.
Democrats are gaslighting the American public. Fraud is real. And it's your tax dollars that fund it.
BACKGROUND
- On January 20, 2026, 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, requested communications, documents, and information from Minnesota Governor Tim Walz and then-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.
- On February 3, 2026, the Subcommittee held a hearing titled Common Schemes, Real Harm: Examining Fraud in Medicare and Medicaid, hearing from experts about the current state of Medicare and Medicaid fraud.
- On March 5, 2026, Chairmen Guthrie, Joyce, and Griffith sent letters to ten additional states-California and New York were among the states to which letters were transmitted-to request information and documents on the actions each state is taking to strengthen Medicaid program integrity.
- On March 17, 2026, the Subcommittee held a hearing titled Protecting Patients and Safeguarding Taxpayer Dollars: The Role of CMS in Combatting Medicare and Medicaid Fraud, featuring U.S. Centers for Medicare and Medicaid Services (CMS) Deputy Administrator Kim Brandt, who provided detailed discussion with Members related to CMS' recent actions to improve program integrity in Medicare and Medicaid.
- Medicaid is an indispensable lifeline for our nation's most vulnerable populations. In order to ensure that Medicaid is there to continue to support future generations of Americans in need, the Working Families Tax Cuts (H.R. 1) strengthened the program for those who need it most.
- Within the Medicaid title of H.R. 1, the House Committee on Energy and Commerce found $806 billion in savings from waste, fraud, and abuse. The Senate version of H.R. 1 will save $1.1 trillion.
- CBO has confirmed that on net states will save money from the elimination of wasteful state mandates, which means more money will be available to reinvest in our traditional Medicaid population.
