Recent high profile fraud cases from states like Minnesota and California involving Medicaid and other public assistance programs have highlighted the failures by government agencies to prevent abuse of the system and protect these taxpayer funds for those truly in need.

The US Department of Health and Human Services Office of Inspector General reported that in 2025 the Medicaid Fraud Control Section of the Pennsylvania Attorney General’s Office ranked first nationally in criminal convictions and third in charges filed against violators. The Pennsylvania Office of State Inspector General, which reviews select benefits applications from the state Department of Human Services, reported $59 million in public assistance fraud prevention last fiscal year and filed 394 criminal complaints. These dramatic statistics demonstrate the significance of the problem in our commonwealth.

More than a third of Medicaid fraud control unit convictions nationally have involved personal care service attendants. Common types of fraud in this category include timesheet falsification, phantom billing of claims for services never provided, unqualified provider billing by caregivers who lack the required training or background checks and kickback arrangements for referrals.

Approximately a third of Medicaid-funded personal care services are provided through participant-directed programs rather than home care agencies. According to a 2025 report by the independent, non-partisan federal Medicaid and CHIP Payment and Access Commission, “limited data reporting and analysis capacities in self-direction may hinder state and national efforts to ensure quality and conduct effective monitoring and oversight.”

To gauge the effectiveness of Pennsylvania’s controls and eligibility verification measures in place to prevent or identify fraud in participant-directed care, the Legislative Budget and Finance Committee (LBFC) should conduct an audit of these programs. This oversight by the General Assembly is necessary to confirm our state agencies are appropriately ensuring taxpayer funds go to their intended purposes and eligible recipients, not into the pockets of fraudsters.

Please join me in supporting this resolution directing the LBFC to perform this audit.