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US Medicaid fraud enforcement and prosecution

Updated 2 times since CLSTR started tracking revisions of this situation.

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2026-09-18 20:45 UTC → 2026-09-20 17:22 UTC · added removed

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 secured convictions in major fraud and identity theft schemes. In Silver City, Susanne Kee and Bethanne Kee were sentenced to four and a half years in prison for using the identities of children and adults to bill Medicaid through a nonprofit, Kids in Need of Support Services. They were ordered to pay $6.6 million in total restitution and penalties. In Las Cruces, therapist Nancy Marshall was sentenced to five years in prison after pleading guilty to fabricating diagnoses to fraudulently bill the state $970,108. Recent legal actions in other states have also targeted large-scale fraud. In Missouri, Attorney General Catherine Hanaway announced felony charges against 17 individuals accused of Medicaid fraud totaling over $450,000 involving identity theft and improper billing. In Arizona, federal prosecutors have detailed Medicaid massive fraud cases involving more than $102 million in billings to schemes targeting the Arizona Health Care Cost Containment System, specifically targeting the American Indian Health Program. This included the sentencing of System (AHCCCS). Nurse practitioner Rita Ntusa Anagho was sentenced to 14 years in prison and an order for defrauding the system of more than $69 million through her Tusa Integrated Clinic, specifically targeting vulnerable patients including Native Americans. She was ordered to pay nearly $55 million in restitution. Additionally, an indictment involving Happy House Behavioral Health LLC alleges the collection of over $60 million through false claims for patients who were deceased, incarcerated, or hospitalized.

Versions

  1. 2026-09-20 17:22 UTC US Medicaid fraud enforcement and prosecution
  2. 2026-09-18 20:45 UTC US Medicaid fraud enforcement and prosecution
  3. 2026-09-10 02:36 UTC US Medicaid fraud enforcement and prosecution

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