Medicaid for millionaires. Jaw-dropping swindles. Bureaucrats who aren't checking patients' eligibility.

As Congress struggles to find spending cuts in a bloated federal budget, a growing number of states are exposing the breathtaking extent of fraud, waste and abuse inside the government's primary medical welfare program for the poor. 

Arizona became the latest state to unveil failures, as Senate Majority Leader Janae Shamp, House Majority Leader Michael Carbone, and other GOP lawmakers released a report showing that 130,000 of the 388,000 state residents who applied for Medicaid last year were not verified, suggesting up to $6 billion a year in Medicaid fraud.

"When we're talking about cutting fraud, waste and abuse, that is exactly where we start," Shamp told Just the News.

The report showed only 24% of Arizonans who applied for the assistance were vetted, and of those people who did get vetted properly, 34% weren't supposed to be accepted, but they got the Medicaid benefits anyway.

When asked if she believes that Arizona's Democratic Governor Katie Hobbs would consult the Republicans who led the effort to investigate, Shamp told Just The News, "I always want to believe in the good that, yes, we can work across party lines, and we can figure out how to do this collectively together, because it's the citizens of Arizona, the taxpayers of Arizona, that are bearing the brunt of this fraud."

"I have sent a letter to her office, and I'm asking for a bunch of questions to be answered and to find out what it is that the governor's office is prepared to do with her agency that is directionless, leaderless...no transparency [and] totally unaccountable," she continued. 

Arizona's Medicaid problems follow similar issues found in states like Ohio where a Bloomberg Law investigation revealed that state health departments and Medicaid contractors often fail to detect or ignore blatant fraud, costing taxpayers billions annually. 

Congressional leaders are targeting an estimated $50 billion in yearly Medicaid waste, as states and contractors prioritize approving claims over scrutinizing questionable expenditures. 

Former officials at Eleanor Slater Hospital in Rhode Island filed a lawsuit alleging Gainwell Technologies LLC, ignored improper billing practices, such as coding the facility as a nursing home to avoid federal oversight. In Ohio, a Gainwell pharmacist claimed leadership instructed him to approve all prescription claims, including unauthorized ones, during a 2022 system rollout. The investigation highlighted systemic issues, with contractors and states working together to bypass checks, enabling fraud like years-long hospitalizations for routine issues like high blood pressure. Such egregious instances of fraud and lack of accountability undermine Medicaid’s integrity, and fuel calls for stronger oversight and enforcement, including in the One Big Beautiful Bill passed by House Republicans and championed by President Donald Trump. 

Also in Ohio, Janay Corbitt, a 36-year-old Dayton woman previously banned from being a Medicaid provider, was sentenced to six to nine years in prison for stealing $1.5 million from Ohio’s Medicaid program, Ohio Attorney General Dave Yost announced. Corbitt pleaded guilty to second-degree felony theft and three third-degree felony counts of identity fraud after an investigation by Yost’s Health Care Fraud Section. She used stolen identities to operate two fraudulent behavioral health counseling agencies in the Dayton area, defrauding the program. The Ohio Medicaid Fraud Control Unit, primarily funded by a $15.3 million federal grant, led the investigation that resulted in her conviction.

A Minnesota man was charged with defrauding Medicaid of $7.4 million through a personal care assistance company he secretly operated despite being barred from participation. The scheme involved billing for services never provided, using falsified records to conceal the fraud. This case reflects a broader issue of exploiting personal care services, a common target due to lax oversight in some states.

A business owner in Charlotte was sentenced to over 16 years in prison for defrauding the North Carolina Medicaid program of more than $11 million. The scheme involved billing for medically unnecessary testing services and paying illegal kickbacks to secure referrals, illustrating how diagnostic labs can manipulate billing practices for profit.

In 2023, Texas' Medicaid Fraud Control Unit secured convictions in multiple cases. Dennis Damian Anugwom, owner of Union Healthcare Services, and Kenric Wakeen Griffin, co-owner of New Horizons Durable Medical Equipment, were prosecuted for fraudulent billing schemes totaling millions. Another case involved ApolloMDx, a genetic testing company, fraudulently billing Medicaid for approximately $142 million by exploiting unnecessary genetic testing orders. These cases highlight the vulnerability of Medicaid’s transportation and durable medical equipment sectors.

Reforming the complicated and intricate Medicaid program must begin at the state level and Ohio is leading the charge in removing millionaires on the program via Ohio State Rep. Mike Dovilla’s introduction of House Bill 356. This legislation is aimed at curbing Medicaid fraud by removing over 10,000 millionaires from the program’s rolls. The legislation mandates asset verification for all Medicaid enrollees and funds a state audit to identify improper enrollments, projecting $1.2 billion in annual savings. Investigations revealed millionaires’ enrollment costs Ohio taxpayers $6.3 billion yearly, prompting bipartisan support for reform.