Labrador Letter: Idaho Urges Congress to Give States the Tools to Stop Medicaid Fraud
Dear Friends,
In May, I told you about a trip to the White House, where I sat down with Vice President JD Vance, FTC Chairman Andrew Ferguson, and other Administration officials to report on what my Medicaid Fraud Control Unit has found in Idaho and to ask for more tools to go after it. This week, I joined South Carolina Attorney General Alan Wilson and attorneys general from 15 other states in a letter to the House Committee on Energy and Commerce and the Senate Committee on Finance, urging them to pass the STOP FRAUD in Medicaid Act and give states one of the tools we asked for.
State Medicaid Fraud Control Units, including the one in my office, are funded in part by the federal government to investigate and prosecute fraud within the Medicaid program. But federal restrictions currently limit that funding to cases involving provider fraud, meaning doctors, clinics, or other providers who bill Medicaid for services they never delivered. If someone instead lies on a Medicaid application or misrepresents their eligibility to receive benefits they are not entitled to, my investigators are largely blocked from using federal MFCU resources to pursue it. The STOP FRAUD in Medicaid Act, introduced as H.R. 5364 and S. 4176, would amend that statute so states can investigate and prosecute recipient fraud with the same authority we already have for provider fraud.
Medicaid is a shared state and federal responsibility, funded by taxpayers to serve people who are disabled, low-income, or otherwise unable to access health care on their own. The program’s integrity depends on enforcing its rules against everyone who breaks them, not just the providers on one side of the transaction. Limiting enforcement to provider fraud alone leaves states unable to reach a whole category of theft from a program meant for people who truly need it.
The Department of Health and Human Services Office of Inspector General found that Medicaid Fraud Control Units recovered $4.64 for every dollar states and the federal government spent on them in fiscal year 2025. Nationally, those units brought in almost $2 billion in criminal and civil recoveries that year and led to the exclusion of 900 individuals and entities from federal health care programs. They did that work while largely locked out of recipient fraud cases entirely. Expand their authority, and those recovery numbers grow.
For Idahoans, this is not an abstract fight over Washington bureaucracy. Every dollar stolen through Medicaid fraud, whether by a provider or a recipient, is a dollar that does not reach a disabled adult, a low-income family, or a child in this state who depends on that coverage. It is also a dollar pulled from Idaho and federal taxpayers who fund the program in good faith. My office already goes after provider fraud aggressively. This bill would let us do the same on the recipient side.
Congress is not the only place I am making this case. In the coming legislative session, I will also be asking the Idaho Legislature for additional authority and resources to strengthen this work at the state level. Fraud does not respect the line between state and federal jurisdiction, and neither should the tools we use to stop it.
Best Regards,
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