Pennsylvanians are Paying a High Price for Medicaid Fraud and Waste

Medicaid is once again in the national spotlight. And as recent events in Minnesota have revealed, the program’s size and complexity make it ripe for waste, fraud, and abuse.

Unfortunately for Pennsylvanians, the Keystone State is no exception.

In 2024, Pennsylvania charged more Medicaid fraud cases than any other state. The Pennsylvania Attorney General reports $11.3 million in Medicaid fraud recoveries and $44 million in fraudulent charges. That same year, Medicaid spending ballooned to nearly $50 billion (including state and federal funds). Since 2018, Medicaid spending has grown by 80 percent, from $30 billion to $54 billion.

Recent Audits of Pennsylvania’s Programs

Over the past three years, Medicaid audits consistently found millions in improper payments.

1. In July 2025, the Office of Inspector General, housed within the U.S. Department of Health and Human Services, reported that Pennsylvania made more than $8.7 million in “unallowable capitation payments for enrollees with multiple Medicaid Identification numbers.”
2. In March 2025,  Pennsylvania’s Auditor General announced that reporting delays from one Medicaid provider,  University of Pittsburgh Medical Center Community HealthChoices, cost taxpayers more than $350,00—$120,000 of which the state couldn’t recover. Paperwork delays lead to taxpayers paying the provider for four individuals after they died.

3. In spring 2024, another audit revealed that Pennsylvania’s school-based program improperly claimed over $550 million in Medicaid funds.

Latest Examples of Medicaid Fraud

• A woman allegedly stole the identities of overseas Pennsylvanians to bill for nearly $1 million in home care services.
• A case manager allegedly stole $72,000 by billing for child clients he didn’t see for a year.
• An unlicensed therapist allegedly billed $7,000 for sessions where he sexually exploited patients.

With 27 percent of Pennsylvanians dependent on Medicaid for health care, the “pay and chase” method must stop. Even Gov. Shapiro, during his time as Attorney General, noted that Pennsylvania is likely losing $3 billion a year to Medicaid fraud.

With a pending $5 billion deficit, Pennsylvania cannot afford to ignore this issue.