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Sen. Ashley Moody Proposes Bill Letting States Prosecute Medicaid Fraud Recipients

Sen. Ashley Moody, R-Fla., is introducing the STOP FRAUD in Medicaid Act, a federal bill that would give state attorneys general and Medicaid Fraud Control Units explicit authority to investigate and prosecute Medicaid beneficiaries who receive fraudulent kickbacks or benefits, not just providers. Moody says her experience as Florida attorney general showed that only going after providers leaves a "small fish" tier of fraud untouched, as federal prosecutors often decline lower-dollar recipient cases and instead rely on anti‑kickback laws. Her office cites Minnesota as a prime example, where years of alleged kickback‑driven fraud in Medicaid‑funded autism services and child care have prompted a new state audit faulting the Department of Human Services for failing to properly probe kickback claims and recommending that kickbacks be clearly defined as fraud in state rules. Minnesota House Fraud Prevention Committee Chair Kristin Robbins, a Republican now running for governor, called the lack of accountability for the "rampant fraud" in the state "astounding," reflecting broader political pressure to tighten enforcement after providers allegedly billed millions while luring families with payments or benefits tied to enrollment. The measure would effectively push more front‑line fraud enforcement down to state AGs and MFCUs, raising questions about how aggressively states might pursue low‑income recipients and what guardrails, if any, would distinguish organized kickback schemes from individual eligibility errors.

Medicaid and Health-Care Fraud Federal and State Law Enforcement Powers

📌 Key Facts

  • Sen. Ashley Moody, R-Fla., is introducing the STOP FRAUD in Medicaid Act to expand enforcement beyond providers to recipients of fraudulent Medicaid benefits.
  • The bill empowers state attorneys general and Medicaid Fraud Control Units to investigate and prosecute beneficiaries involved in kickback‑based or other recipient‑side Medicaid fraud.
  • Moody’s office argues federal prosecutors can technically charge recipients under anti‑kickback laws but often let "small fish" cases go, leaving gaps in enforcement.
  • Minnesota’s long‑running Medicaid fraud scandals, including autism‑services kickback schemes and a state audit faulting the Department of Human Services for weak investigations, are highlighted as a key rationale for the bill.
  • Minnesota House Fraud Prevention Committee Chair Kristin Robbins says the continuing lack of accountability for widespread fraud in the state is "astounding" and has urged legislative fixes.

📊 Relevant Data

In 2023, Medicaid/CHIP enrollees in the US were distributed as follows: White 40.3%, Hispanic 31.5%, Black 18.4%, Asian 4.9%, compared to US population percentages of approximately White 58%, Hispanic 19%, Black 13%, Asian 6%.

Medicaid/CHIP enrollees share by ethnicity U.S. 2023 — Statista

In fiscal year 2024, the national Medicaid improper payment rate was estimated at 6.1%, with 79.11% of improper payments resulting from insufficient documentation.

Fiscal Year 2024 Improper Payments Fact Sheet — CMS

In Minnesota, the Medicaid improper payment rate was 2.1% for the reviewed period, compared to the national average of 6.1%.

Federal review determines rate of improper payments in Minnesota's Medicaid program — Minnesota Department of Human Services

Among offenders sentenced for government benefits fraud in recent years, 62.4% were Black, 19.7% White, 14.1% Hispanic, and 3.8% Other races, compared to US population percentages of Black 13%, White 58%, Hispanic 19%.

Government Benefits Fraud — United States Sentencing Commission

In fiscal year 2024, Medicaid Fraud Control Units across the US achieved recoveries of $3.46 for every $1 spent on operations, with a total of 1,472 convictions.

Medicaid Fraud Control Units Annual Report: Fiscal Year 2024 — OIG

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