Fighting Medicaid Fraud is a Good Investment and Good Policy – The Numbers Show It
Last year’s HHS-OIG report on Medicaid enforcement actions shows that investing in fraud fighting works: the return on investment for every dollar invested in State Medicaid Fraud Control Units (MFCUs) was a whopping 464%, with recoveries at roughly $2 billion in total.
For law enforcement, this is an impressive return on taxpayer money. For healthcare providers, it is a reminder that Medicaid fraud remains a top enforcement priority. And for whistleblowers and relators, it underscores that governments continue to rely heavily on information from whistleblowers to identify fraud schemes that might otherwise remain hidden.
The report’s numbers are striking. During FY 2025, MFCUs, state-federal law enforcement teams that focus on Medicaid fraud in each state or territory, reported:
• Nearly $2 billion in total recoveries;
• 1,185 criminal convictions, including 856 fraud convictions;
• 674 civil settlements and judgments; and
• 900 exclusions from participation in federal healthcare programs.
These statistics demonstrate that Medicaid fraud enforcement is not slowing nor becoming less efficient. Instead, federal and state authorities continue to devote substantial resources to identifying fraudulent billing, kickback arrangements, medically unnecessary services, and abuse of Medicaid-funded programs.
And the numbers show it. Numbers of convictions, settlements, judgments, and recoveries were all higher than the previous year,1 and the ROI on taxpayer investment grew an astonishing 34% year-over-year.2
Several trends in the report are particularly noteworthy. Pharmaceutical manufacturers accounted for more civil settlements than any other provider category,3 reflecting continued scrutiny of pricing, rebate, and marketing practices, especially vis-à-vis the Anti-Kickback Statute. At the same time, personal care services attendants generated more fraud convictions than any other provider type,4 illustrating the government’s increasing focus on home-and community-based services, an area that continues to experience rapid Medicaid expansion.
For healthcare providers, the statistics serve as a reminder that robust compliance programs are not simply regulatory best practices—they are an essential risk management tool. Internal reporting mechanisms, proactive auditing, prompt investigation of employee concerns, and timely corrective action can identify problems before they become the subject of government investigations.
For whistleblowers, and potential whistleblowers, the report offers a different lesson. The government’s extraordinary return on investment reflects the fact that fraud enforcement continues to generate significant recoveries for Medicaid programs. Employees who identify credible evidence of fraud remain among the government’s most valuable sources of information, and the False Claims Act continues to provide a powerful mechanism for bringing those schemes to light while protecting eligible relators who come forward with non-public information.
If one number captures the current state of Medicaid fraud enforcement, it is 464%—a reminder that investments in fraud enforcement continue to produce substantial returns, and that healthcare fraud remains firmly in the government’s crosshairs.
This piece was written by Max Voldman, a Partner at Whistleblower Partners LLP
1 Medicaid Fraud Control Units Annual Report: Fiscal Year 2024, Dep’t Health & Hum. Servs. Off. Inspector Gen. (Mar. 2025), https://oig.hhs.gov/documents/evaluation/10227/OEI-09-25-00090.pdf (detailing 1,151 convictions, 493 settlements and judgments, and $1.4 billion in recoveries for fiscal year 2024).
2 Id. In Fiscal Year 2024, MFCUs recovered $3.46 for every $1 spent compared to $4.64 for every $1 in Fiscal Year 2025.
3 Medicaid Fraud Control Units Annual Report: Fiscal Year 2025, Dep’t Health & Hum. Servs. Off. Inspector Gen. (Mar. 2026), https://oig.hhs.gov/documents/evaluation/11553/OEI-09-26-00140.pdf (noting 121 pharmaceutical manufacturer civil settlements and judgments).
4 Id. (reporting 326 personal care service attendant fraud convictions).
