What counts as Medicaid fraud
Medicaid is run by the HHS / Centers for Medicare & Medicaid Services, with states handling eligibility and day-to-day payments. Common schemes include:
- Billing for services that were never provided
- Billing for a more expensive service than the one delivered (upcoding)
- Kickbacks for patient referrals
- Home care, personal care or housing support billed for clients who never received it
- Enrolling people who are not eligible
Honest mistakes and disputes over a single bill are not fraud. Fraud means someone knowingly took money they were not entitled to.
Where to report it
| Contact | Handles |
|---|---|
| HHS Office of Inspector General 1-800-HHS-TIPS (1-800-447-8477) | Fraud in Medicare, Medicaid and other HHS programs |
| Your state's Medicaid Fraud Control Unit | State unit, usually in the Attorney General's office, that prosecutes provider fraud |
| America.gov/fraud (WHIP reward portal) | Required route if you want a WHIP award of $10,000–$30,000 |
Because states run Medicaid day to day, your state agency is often the fastest route. Each state's page in the fraud case database lists its reporting contacts.
Can you get a reward?
Yes. HHS / Centers for Medicare & Medicaid Services programs are covered by the federal Fraud Whistleblower Incentive Program (WHIP): a written tip that leads to criminal charges can earn $10,000–$30,000. For larger frauds, the False Claims Act pays 15–30% of what the government recovers.
- WHIP: submit in writing at America.gov/fraud, include your contact details, and do not take part in the fraud. Step-by-step guide.
- False Claims Act: a sealed lawsuit filed through a lawyer; worthwhile mainly for frauds of $1 million or more. Compare the routes.
- State laws: many states have their own false claims acts. Check your state's page in the case database.
Estimate your own case with the reward calculator.
What to include in your report
- Who: names of people and businesses, addresses, provider or license numbers if you have them
- What: the service, benefit or loan involved and what was wrong with it
- When and how often, and roughly how much money
- How you know: what you saw, and any documents or photos you are allowed to share
Where Medicaid fraud is being prosecuted
States with the most Medicaid announcements in our database since January 20, 2025; the largest amount named is $556M (settlement):
| State | Announcements |
|---|---|
| New York | 30 |
| Massachusetts | 24 |
| Connecticut | 14 |
| Pennsylvania | 14 |
| Texas | 14 |
| California | 13 |
| Wisconsin | 13 |
| Virginia | 13 |
Recent Medicaid fraud cases
| Date | Announcement | State | Stage | Amount |
|---|---|---|---|---|
| 2026-10-20 | Illinois Laboratory Owner Charged in $66M COVID-19 Testing Fraud Scheme | Illinois | Charged | $66.2M |
| 2026-10-16 | Connecticut Physician and His Practices Pay More Than $860K to Settle False Claims Act Allegations | Connecticut | Civil settlement | $867K |
| 2026-10-15 | Charlotte Man Pleads Guilty to Health Care Fraud for Stealing Hundreds of Thousands from the North Carolina Medicaid Program | North Carolina | Pleaded guilty | — |
| 2026-10-09 | Maryland Man Facing Federal Indictment for Role in COVID-19 Healthcare Fraud Scheme Totaling More Than $100M | Maryland | Charged | — |
| 2026-10-08 | Minnesota Woman Convicted in $3.6M Scheme to Defraud Medicaid Housing Services Program | Minnesota | Convicted at trial | $3.6M |
| 2026-10-02 | Social Adult Day Care Owner Pleads Guilty to $65M Medicaid Fraud | New York | Pleaded guilty | $65M |
| 2026-10-02 | Doctor Convicted for Conspiring to Distribute Over 2 Million Stimulant Pills | Multi-state | Convicted at trial | — |
| 2026-10-01 | Worcester Man Indicted for Snap Fraud | Massachusetts | Charged | — |
Source: U.S. Department of Justice press releases. Charged cases are allegations. All 302 Medicaid announcements
Frequently asked questions
Where do I report Medicaid fraud?
HHS Office of Inspector General (1-800-HHS-TIPS (1-800-447-8477)): Fraud in Medicare, Medicaid and other HHS programs. Your state's Medicaid Fraud Control Unit: State unit, usually in the Attorney General's office, that prosecutes provider fraud. America.gov/fraud (WHIP reward portal): Required route if you want a WHIP award of $10,000–$30,000.
Can I get a reward for reporting Medicaid fraud?
Yes. HHS / Centers for Medicare & Medicaid Services programs are covered by the federal Fraud Whistleblower Incentive Program (WHIP): a written tip that leads to criminal charges can earn $10,000–$30,000. For larger frauds, the False Claims Act pays 15–30% of what the government recovers.
Can I report Medicaid fraud anonymously?
Most inspector general hotlines accept anonymous tips. To be paid a WHIP award, though, you must give contact information and disclose your identity to the Justice Department before payment; you can stay anonymous during the process only through a lawyer.
How common is Medicaid fraud prosecution?
Our database has 302 Justice Department announcements involving Medicaid since January 20, 2025, counting each press release separately.