Attorney General Dave Sunday has released an annual report indicating that Pennsylvania's Medicaid Fraud Control Section leads the nation in the number of fraud charges filed against individuals. The section also ranks third in terms of convictions secured. This initiative targets those who exploit Pennsylvania’s Medicaid program, which provides healthcare access to low-income and vulnerable populations.
The section, part of the Office of Attorney General, focuses on prosecuting individuals involved in unlawful billing or failure to provide services. It also addresses cases involving neglect or abuse of dependent Pennsylvanians and financial exploitation of older adults or care-dependent persons.
In the 2024 federal fiscal year, the section recovered over $11.3 million in misused Medicaid funds, primarily through criminal prosecutions. During this period, 113 people faced fraud charges, while six were charged with neglect, abuse, and endangerment. The unit secured convictions in 74 cases from both current and previous years.
"Those who defraud our Medicaid program take vital services away from those in need while violating taxpayers who help fund the program," said Attorney General Sunday. "I am proud of our unit’s ranking among peers and assure Pennsylvanians that our commitment to expose waste, fraud and abuse, and to prosecute offenders will not stop."
A report by the U.S. Department of Health and Human Services Office of Inspector General notes that Medicaid Fraud units nationwide recover $3.46 for every dollar spent by these units.
Recent efforts by Pennsylvania's Office of Attorney General include actions against Medicaid Fraud in southeastern Pennsylvania. However, it is important to note that criminal charges are merely allegations until proven otherwise.
The Pennsylvania Medicaid Fraud Control Unit receives significant funding support from a grant awarded by the U.S. Department of Health and Human Services totaling $12,839,940 for Federal fiscal year 2025. The remaining portion amounting to $4,279,979 is funded by Pennsylvania.