Medicaid Fraud comes in many guises

The OBBBA has allowed CMS to search out waste, fraud, and abuse in Medicaid for the first time. The early results show that both Medicaid and Medicare are experiencing vast amounts of fraud:

https://www.cms.gov/newsroom/press-releases/cms-finds-28-million-americans-potentially-enrolled-two-or-more-medicaid/aca-exchange-plans

CMS Finds 2.8 Million Americans Potentially Enrolled in Two or More Medicaid/ACA Exchange Plans
July 17, 2025
Unnecessary, Duplicate Enrollment Wasting $14 Billion Annually

The Centers for Medicare & Medicaid Services (CMS) continue to crush fraud, waste, and abuse in America’s healthcare programs by stopping duplicative enrollment in government health programs, with the potential to save taxpayers approximately $14 billion annually.

A recent analysis of 2024 enrollment data identified 2.8 million Americans either enrolled in Medicaid or the Children’s Health Insurance Program (CHIP) in multiple states or simultaneously enrolled in both Medicaid/CHIP and a subsidized Affordable Care Act (ACA) Exchange plan.

CMS is taking action to ensure individuals are only enrolled in one program and to stop the federal government from paying multiple times for these individuals to receive health coverage. In addition, as a result of the One Big Beautiful Bill Act, CMS now has new tools to prevent the federal government from paying twice for the same person’s care—saving billions and restoring integrity to the system.

"HHS staff uncovered millions of Americans who were illegally or improperly enrolled in Medicaid and ACA plans," said U.S. Health and Human Services Secretary Robert F. Kennedy, Jr. "Under the Trump Administration, we will no longer tolerate waste, fraud, and abuse at the expense of our most vulnerable citizens. With the passage of the One Big Beautiful Bill, we now have the tools to strengthen these vital programs for generations to come."

“The Biden Administration struggled to ensure that individuals were only enrolled in the single Medicaid or Exchange plan for which they were eligible, that ends today,” said CMS Administrator Dr. Mehmet Oz. “CMS is restarting these important checks to follow federal law. We are going to work with states to identify individuals enrolled in multiple programs and fix the duplicate enrollment problem to save taxpayers billions of dollars, while minimizing inappropriate coverage loss. This is exactly why we fought for stronger tools in the One Big Beautiful Bill Act—to go after this type of waste and finally put a stop to paying twice for the same person’s health coverage.”

Over the past several months, software engineers collaborated with CMS to examine historical program enrollment data and found that in 2024 an average of 1.2 million Americans each month were enrolled in Medicaid/CHIP in two or more states and an average of 1.6 million Americans each month were enrolled in both Medicaid/CHIP and a subsidized Exchange plan.

Federal regulations require Exchanges to periodically examine data for dual enrollments in Medicaid to guard against improper enrollments in subsidized Exchange plans through a process called Medicaid Periodic Data Matching (PDM). These essential examinations were strengthened under the first Trump Administration and increased to at least twice a year. These examinations were paused under the Biden Administration to ensure that continuous coverage was maintained during the PHE, in alignment with the statutory requirement on states to maintain continuous enrollment in Medicaid or CHIP throughout the COVID public health emergency.

CMS will partner with states to reduce duplicate enrollment through three initiatives:

*    Individuals Enrolled in Two or More Medicaid Programs: CMS will provide states with a list of individuals who are enrolled in Medicaid or CHIP in two or more states and ask states to recheck Medicaid or CHIP eligibility for these individuals. CMS will work with states to prevent individuals from losing coverage inappropriately.

*    Individuals Enrolled in Medicaid or CHIP + a Subsidized Federally-facilitated Exchange (FFE) Plan: CMS notified individuals enrolled in both Medicaid or CHIP and an FFE plan with a subsidy. These individuals are asked to take one of the following actions:

1) Disenroll from Medicaid or CHIP, if no longer eligible;

2) End their subsidy (with the option to end their coverage); or

3) Notify the Exchange that the data match is incorrect and submit supporting documentation to show they are not enrolled in both Medicaid/CHIP and subsidized Exchange coverage.

After 30 days, the FFE will end the subsidy for individuals who still appear to be enrolled in both Medicaid or CHIP and an Exchange plan with a subsidy.

*    Individuals Enrolled in Medicaid or CHIP + a Subsidized State-based Exchange (SBE) Plan: CMS will provide SBEs with a list of individuals who are potentially enrolled in the state’s Medicaid or CHIP and a subsidized Exchange plan and ask SBEs to determine whether these individuals are dually enrolled, and if so, to implement a process, similar to the federal Exchange, to recheck eligibility. CMS will work with states to prevent individuals from losing coverage inappropriately.

CMS will provide additional guidance to state Medicaid and CHIP agencies in early August with expectations for tackling concurrent enrollment. The agency will follow up with lists to each state of individuals concurrently enrolled in Medicaid or CHIP and ask states to make their best efforts to recheck eligibility by late fall. Going forward, CMS will continue to work with states to provide support for their existing Medicaid/CHIP and Exchange data matching processes and work to implement new requirements in the One Big Beautiful Bill Act designed to eliminate and prevent duplicate enrollment in Medicaid programs.

SNAP news the mainstream media won't publish:

https://www.themidwesterner.news/2025/08/michigan-employee-sues-mdhhs-alleges-termination-for-exposing-co-workers-stealing-federal-food-benefits/

https://mirs-uploads.s3.us-east-2.amazonaws.com/7536-Butler%20complaint.pdf

Michigan employee sues MDHHS, alleges termination for exposing co-workers stealing federal food benefits
'Program has been infiltrated by transnational and domestic groups, and those groups are stealing at scale'
By Victor Skinner - August 7, 2025

Former longtime Michigan Department of Health and Human Services employee Ashanta Butler is suing after she was allegedly fired for exposing co-workers stealing federal food benefits.

Butler filed a federal lawsuit last month in the Eastern District of Michigan that alleges she was fired after 23 years with no complaints for exposing a scheme by her co-workers to steal taxpayer-funded benefits through the Supplemental Nutrition Assistance Program, also known as SNAP or food stamps.

“In or around early 2024, Plaintiff reported concerns to the Office of the Attorney General of the State of Michigan regarding fraudulent activity by State employees who were allegedly conspiring to unlawfully receive public benefits, including food assistance,” according to the lawsuit.

“Plaintiff’s report identified that her assigned union steward, Mona Lyndsey, was directly involved in the fraudulent scheme and was aiding another state worker in unlawfully obtaining benefits,” it read. “Shortly after Plaintiff made the protected report, her supervisor, Rachel Hill, informed her that she had been instructed by Manager Angela Barbee to target and ‘get rid of’ Plaintiff due to her cooperation with the Michigan Department of Corrections and her role as a whistleblower.”

“Angela Barbee, who was later transferred to another office for engaging in similar conduct, was among the managers implicated in the benefits fraud reported by Plaintiff,” according to the lawsuit.

The complaint contends human resources director Suzanne Gralinski in April 2024 told Butler “your kind is not welcome in Macomb County,” which Butler, a Black woman, took as a racially discriminatory statement.

Butler alleges Gralinski attempted to force her to sign a document stating she would never accept employment with the state again, but Butler refused, prompting Gralinski to promise she would be “blackballed in Lansing” and never work in Macomb County again, according to the complaint.

The lawsuit alleges Butler “was subjected to a pattern of escalating retaliation by her employer” before she was ultimately terminated on April 10, 2024.

“Plaintiff believes her termination was motivated by unlawful retaliation for her protected whistleblowing activity, and by unlawful discrimination based on her race,” the lawsuit reads. “Plaintiff has suffered substantial damages as a result of Defendants’ conduct, including lost wages, reputational harm, emotional distress, and diminished future employment opportunities.”

The lawsuit comes as the SNAP benefits program 800,000 low-income Michiganders depend on reported a nearly 400% increase in fraud between fiscal years 2023 and 2024.

The cost of scams involving electronic benefit cards used for food stamps in Michigan skyrocketed from $181,778 in replaced benefits in 2023 to $884,947 last year.

Michigan House members take on SNAP fraud this week, just two months after Mackinac Center exposed how bad the problem really is.

The committee tasked with hearing this issue is the House Committee on Government Operations.

Leadership

Rep. Brian BeGole (Republican) District-71
Chair

Rep. Mike Harris (Republican) District-52
Majority Vice Chair

Rep. John Fitzgerald (Democrat) District-83
Minority Vice Chair

Members

Rep. Curtis VanderWall (Republican) District-102

Rep. Mike McFall (Democrat) District-14

This committee's minutes,  testimony, and information to contact members, the committee secretary, and sign up for agenda notices are all located on the committee home page.

House Committee on Government Operations

Thursday, August 21, 2025              9:00 AM

AGENDA

HB 4746 (Rep. Woolford)   Human services: food assistance; chip-enabled bridge cards; require.

OR ANY BUSINESS PROPERLY BEFORE THIS COMMITTEE

SNAP sales reps embedded in MDHHS two years ago this week. 

Correlation is not causation, but someone needs to ask: did this in any way contribute to the explosion of Bridge Card abuse?

Govt Operations Committee added another anti-fraud bill:

AGENDA

HB 4515 (Rep. Woolford)

Human services: food assistance; recipient's digital photographic image and signature printed on the Michigan bridge card; require.

HB 4746 (Rep. Woolford)

Human services: food assistance; chip-enabled bridge cards; require.

OR ANY BUSINESS PROPERLY BEFORE THIS COMMITTEE

Excellent data find this week while researching for a Medicaid Reform presentation.

I never knew the HHS OIG had an Office of Evaluations and Inspections to prosecute Medicaid fraud.

Medicaid Fraud Control Units Annual Report: Fiscal Year 2024

More SNAP news the mainstream media won't publish because it could adversely affect budget negotiations in Lansing:

https://www.themidwesterner.news/2025/09/rep-jason-woolford-benefit-errors-by-whitmers-mdhhs-will-cost-taxpayers-415-million/

Rep. Jason Woolford: Benefit errors by Whitmer’s MDHHS will cost taxpayers $415 million
Over the last year, fraud in the SNAP program has increased 387%
By Victor Skinner | September 30, 2025

Gov. Gretchen Whitmer’s Department of Health and Human Services is on track to cost taxpayers $415 million more than necessary this year due to errors in administering benefits.

The One Big Beautiful Bill, signed into law by President Donald Trump in July, requires states with payment error rates that eclipse 10% to repay funding to the federal government. State Rep. Jason Woolford, R-Howell, expects the state’s largest agency’s history of problems will cost taxpayers $300 million, in addition to the cost of stolen benefits.

The issue stems mainly from the soaring error rate for Michigan DHHS’ Bridge Cards, which is tied to the department’s failure to properly verify applicants for the federal Supplemental Nutrition Assistance Program, also known as SNAP or food stamps.

“The fact that DHHS is aware of Michigan’s high SNAP error rate and is doing little to fix it is outrageous,” Woolford said last month following a House Oversight Committee hearing with DHHS Director Elizabeth Hertel. “Fraudsters are abusing Bridge Cards because DHHS doesn’t have a system in place to properly verify applicants’ identities. That means individuals are receiving benefits they aren’t entitled to, and Michigan taxpayers are footing the bill. Enough is enough.

“Michigan families deserve better, and they deserve results, not excuses. Programs designed to protect children must actually protect them,” Woolford said in a statement. “The SNAP error rate must be reduced, fraud must be stopped, and every taxpayer dollar must be accounted for. It’s time to repair these broken systems and restore real accountability at DHHS.”

The Michigan DHHS is the largest agency in state government with a budget of $37.5 billion and nearly 16,000 employees.

In addition to SNAP benefits, the department administers Medicaid; the Medicare Savings Program; Women, Infants and Children; the Family Independence Program; and other cash benefit programs, according to Michigan Capitol Confidential.

Over the last year, fraud in the SNAP program has increased 387%, in large part from card skimmers and cloning scams.

Woolford noted in a committee hearing in August that losses from those scams alone jumped from $181,000 in 2023 to $885,000 last year, with the state on pace to surpass the latter by the first quarter of 2025.

During 2024, DHHS sent 738 replacement Bridge Cards every day, equating to more than 269,000 for the year, MCC reports.

“You can image if it’s happening there, then it’s definitely happening in the cash assistance program as well,” Woolford told the news site of the SNAP fraud. “And this is something that we will be looking into.”

Woolford is promoting two bills that he believes will cut down on fraud in the SNAP program that 1.4 Michiganders rely on.

Woolford’s House Bill 4746 would require Michigan’s Bridge Cards to incorporate security chips that are a standard feature in modern credit cards, while House Bill 4515 would require those cards to include a photo and signature of all adults authorized to use them.

“DHHS is entrusted with billions of taxpayer dollars, yet somehow can’t provide the essential services our residents rely on. That is absurd,” Woolford said in August. “This department must be held accountable for this unacceptable performance.”

Michigan’s error rate in 2022 stood at 13%, before it dropped to 10% in 2023. For the current fiscal year, it’s hovering around 9.53%, MCC reports.

DHHS distributed over $60 million in cash benefits to more than 64,000 people this year through the Family Independence Program, state disability insurance, and a Refugee Cash Assistance program.

Woolford suggested to MCC that cutting down on errors at DHHS requires both increased oversight and better leadership, both of which Republicans are focused on moving forward.

“We’ll be looking into possibly breaking that department up, and doing it for the sake of the people who deserve these benefits,” he said. “(Hertel’s) managing people who she’s not holding accountable to the point that it’s costing hundreds of millions of dollars to you and I and taxpayers, and that’s not fair.”

Note that much of this fraud is being committed by out of state hackers.  Health care is also plagued by frauds committed by out of state hackers as well.

The original hearing on SNAP/ Bridge Card security.

Thursday, June 5, 2025    9:00 AM

AGENDA

HB 4515 (Rep. Woolford)
Human services: food assistance; recipient's digital photographic image and signature printed on the Michigan bridge card; require.

OR ANY BUSINESS PROPERLY BEFORE THIS COMMITTEE

Another megadollar health care fraud, this against Medicaid in NYC.  $ 68 million stolen:

https://www.justice.gov/opa/pr/two-individuals-plead-guilty-68m-adult-day-care-fraud-scheme

Two Individuals Plead Guilty to $68M Adult Day Care Fraud Scheme
DoJ Office of Public Affairs

January 15, 2026
For Immediate Release

Two defendants pleaded guilty today to conspiring to defraud Medicaid by paying health care kickbacks for services that were not provided at two Brooklyn social adult day cares and a home health care company.

“The defendants were large-scale recruiters who bribed patients with laundered cash and billed Medicaid over $68 million for services that were not provided,” said Assistant Attorney General A. Tysen Duva of the Justice Department’s Criminal Division. “Today’s guilty pleas demonstrate the Department’s longstanding commitment to rooting out fraud in government health care programs by aggressively prosecuting those who steal from taxpayer-funded programs.”

“As demonstrated by today’s guilty pleas, our Office will hold accountable corrupt individuals who steer patients to health care providers in exchange for illicit kickbacks,” said U.S. Attorney Joseph Nocella Jr. of the Eastern District of New York. “We will continue to investigate and aggressively prosecute fraud schemes that steal from taxpayer funds from federal health care programs.”

“These defendants orchestrated an egregious scheme involving illegal kickbacks to steer Medicaid claims and to receive payment for services not rendered,” said Special Agent in Charge Naomi Gruchacz of the Department of Health and Human Services, Office of Inspector General (HHS-OIG). “Extensive fraudulent operations like this jeopardize the availability of federal health care program funds intended to support millions of beneficiaries. HHS-OIG is committed to working with our law enforcement partners to bring to justice those who prioritize greed over patient care.”

“These defendants placed profit over people and public well-being and stole $68 million in welfare funds meant for those who need it most,” said Special Agent in Charge Ricky J. Patel of Immigrations and Customs Enforcement Homeland Security Investigations (HSI) New York. “Their guilty pleas today reflect that they knew exactly what crimes they were committing — they were cheating the system and, in turn, hurting vulnerable Americans. I commend HSI New York and our law enforcement partners for their unrelenting focus on dismantling and disrupting financial fraud schemes that exploit the American public and hurt our economy.”

According to court documents, Manal Wasef, 46, and Elaine Antao, 46, both of Brooklyn, were marketers and recruiters for two social adult day cares: Happy Family Social Adult Day Care Center Inc. and Family Social Adult Day Care Center Inc., as well as Responsible Care Staffing Inc., a home health care fiscal intermediary. Between approximately October 2017 and July 2024, in exchange for illegal kickbacks and bribes, Wasef and Antao referred Medicaid recipients to the social adult day cares and the home health company. The defendants also paid illegal kickbacks and bribes to Medicaid recipients for social adult day care services and home health care services that were billed to Medicaid but were not provided or that were induced by kickbacks and bribes. Wasef and Antao used multiple business entities to launder the fraud proceeds and generate the cash used to pay kickbacks and bribes. In connection with their guilty pleas, Wasef and Antao agreed to collectively forfeit approximately $1 million. Wasef and Antao are the sixth and seventh individuals, respectively, to plead guilty in this case.

Wasef and Antao pleaded guilty to conspiracy to commit health care fraud. Antao is scheduled to be sentenced on May 20 and Wasef is scheduled to be sentenced on May 27. They each face a maximum penalty of 10 years in prison. A federal district court judge will determine any sentence after considering the U.S. Sentencing Guidelines and other statutory factors.

HHS-OIG, HSI, and the NYPD are investigating the case.

Trial Attorneys Patrick J. Campbell and Leonid Sandlar of the Criminal Division’s Fraud Section are prosecuting the case and Assistant U.S. Attorney Michael Castiglione for the Eastern District of New York is handling forfeiture matters.

The Fraud Section leads the Criminal Division’s efforts to combat health care fraud through the Health Care Fraud Strike Force Program. Since March 2007, this program, currently comprised of 9 strike forces operating in 27 federal districts, has charged more than 5,800 defendants who collectively have billed federal health care programs and private insurers more than $30 billion. In addition, the Centers for Medicare & Medicaid Services, working in conjunction with HHS-OIG, are taking steps to hold providers accountable for their involvement in health care fraud schemes. More information can be found at www.justice.gov/criminal-fraud/health-care-fraud-unit.