# US Medicaid fraud enforcement and prosecution

> Live situation record from CLSTR: https://clstr.news/situations/us-medicaid-fraud-enforcement-and-prosecution
> Updated: 2026-09-08T23:54:18.000Z. Sources: 7. Developments: 2.

Medicaid fraud enforcement and oversight have come under scrutiny in several U.S. states. In New York, the Office of Medicaid Inspector General has seen a decline in audits, referrals, and inflation-adjusted recoveries between 2019 and 2024, even as state Medicaid spending increased from $72 billion to $101 billion. In Nevada, allegations regarding the prosecution of fraud cases have become a political issue during the gubernatorial race.

In New Mexico, authorities have successfully prosecuted significant fraud and identity theft schemes. In Silver City, two individuals associated with a nonprofit were sentenced to prison and ordered to pay $6.6 million in restitution and penalties for billing Medicaid for services never provided. In Las Cruces, a therapist was sentenced to five years in prison after fabricating diagnoses to fraudulently bill the state nearly $1 million.

## Timeline

### 2026-09-08: New Mexico authorities prosecute major Medicaid fraud schemes

New Mexico officials have sentenced several individuals, including a therapist and a mother-daughter duo, for multi-million dollar Medicaid fraud and identity theft schemes.

5 sources. https://clstr.news/cluster/new-mexico-authorities-prosecute-major-medicaid-fraud-schemes

### 2026-08-25: Medicaid fraud enforcement faces scrutiny in New York and Nevada

Medicaid fraud enforcement is under scrutiny as New York reports declining audits and recoveries while Nevada's gubernatorial candidates debate the effectiveness of fraud prosecutions.

2 sources. https://clstr.news/cluster/medicaid-fraud-enforcement-faces-scrutiny-in-new-york-and-nevada

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Cite as: US Medicaid fraud enforcement and prosecution. CLSTR, https://clstr.news/situations/us-medicaid-fraud-enforcement-and-prosecution