Medicaid Fraud is Costing Taxpayers; It’s Time for PA to Act

By Reps. Seth Grove (R-Dover) and Kate Klunk (R-Hanover)

A recent nationwide crackdown on Medicaid fraud exposed a deeply troubling reality. Taxpayer-funded health care is being exploited on a massive scale. The U.S. Department of Justice announced charges against 324 individuals, nearly 100 of whom were licensed medical professionals, in connection with schemes totaling more than $14.6 billion in intended losses. That’s not a typo: $14.6 billion.

The $14.6 billion in alleged fraud amounts to nearly one-third of Pennsylvania’s entire state budget, and that’s just what investigators uncovered. The actual scope of Medicaid fraud is likely much larger and remains hidden in the shadows.

Here in Pennsylvania, the news hit especially close to home. Among those charged was a Bucks County woman accused of defrauding Medicaid of more than $1 million. This case underscores the hard truth that Pennsylvania is not immune, and we cannot afford to turn a blind eye.

This is not just a federal problem; it is a Pennsylvania problem. And it’s time for us to act.

That’s why we are supporting the Program Integrity and Innovation package, a legislative plan aimed at rooting out fraud and ensuring Medicaid dollars go to those who truly need them. This isn’t just about preventing crimes; it’s about protecting the hard-earned money of Pennsylvania’s taxpayers and ensuring the limited resources we have are used as intended.

The legislation is:

	•	The Pennsylvania False Claims Act would increase the Commonwealth’s share of recovered fraudulent funds under a successful lawsuit involving federal and state funds by 10%. For example, if in a particular Medicaid fraud case Pennsylvania’s share of recovered funds is 50% with the federal government taking the other half, the state would instead be entitled to 60%.
	•	House Bill 399 would provide the Department of Human Services with the tools needed to assist in providing and protecting our crucial safety net while ensuring it can operate within its approved budget.
	•	House Bill 595 calls for a coordinated approach to providing mental health, substance abuse and primary care services in the Medicaid program to produce the best outcomes and to best care for people with complex health needs.
	•	Houe Bill 330 would establish a searchable database of a variety of sources that would help identify organizations, individuals and entities that are not eligible to receive funds from a Commonwealth agency. The bill is modeled after the federal Do Not Pay law.
	•	House Bill 979 would require agencies to review their programs and expenditures and assess whether they are highly, moderately or unlikely to be susceptible to an improper payment.

Pennsylvania can no longer afford to wait. We need tougher enforcement and a renewed commitment to accountability. We must equip officials with the tools to pursue fraudsters and recover stolen funds. Every dollar fraudulently claimed is a dollar that can’t be used for what it is meant for. We cannot allow fraudsters to line their pockets at the expense of some of our most vulnerable citizens.

The Legislature has the opportunity and the responsibility to act. It’s time to get to work and close the door on Medicaid fraud in the Commonwealth.

Representative Seth Grove
Greg Gross ggross@pahousegop.com
Representative Kate Klunk
Katelin Morrison kmorrison@pahousegop.com
Pennsylvania House of Representatives