Swing-state's fraud reckoning raises Minnesota-style alarm as wild schemes exposed

The DOJ’s expanded anti-fraud task force made its first sweeping bust of Medicaid scofflaws in Pennsylvania this month, drawing comparisons to the massive fraud scandals that rocked Minnesota — but with one major difference.

Republicans and Democrats in the state united in outrage after nearly two dozen people were charged in Philadelphia and elsewhere. The DOJ noted Pennsylvania spends $8 billion on Medicaid home-care services , more than almost any other state, and those services were the target of the busts.

"The allegations are really disturbing just as they are in Minnesota and other places where we've seen this," House Ways & Means Committee member Lloyd Smucker, R-Pa., told Fox News Digital in an exclusive interview.

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"It's criminal activity that is taking money from individuals who really need it. And this is this is Medicaid — It's not Medicare, which is more for seniors. But this is for people who truly need help, who are disabled — these are individuals who are relying on Medicaid to help them get through every day. And these are criminals who are taking that money and lining their pockets with it," said Smucker, whose Lancaster-area district has an older population and has anywhere from two in 10 to four in 10 constituents enrolled in Medicare, Medicaid or both, according to reports.

The DOJ’s anti-fraud chief echoed those sentiments while describing some of the most egregious cases among the 19 Pennsylvania defendants charged as of last week.

One suspect billed Medicaid for services that supposedly occurred while police had pulled him over for a moving violation and charged him on suspicion of marijuana possession, according to the DOJ.

Another suspect billed Medicaid for services during a period when he was in court watching a family member get sentenced for Medicaid fraud-related offenses, according to Colin McDonald.

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Another suspect billed Medicaid for home-care services that McDonald said were supposedly provided while the suspect was driving for a rideshare company. Another billed for services while in prison, according to McDonald.

Smucker said Pennsylvania welcomes fellow Keystone Stater and CMS Administrator Mehmet Oz and his investigators, adding that he is grateful state officials in Harrisburg are also taking note.

That cooperation sets the Pennsylvania busts apart from those in Minnesota, where Gov. Tim Walz has faced accusations of inaction over what has become a multibillion-dollar scandal.

Pennsylvania Gov. Josh Shapiro signaled cooperation and collaboration with Republicans in going after Medicaid fraudsters in remarks his office made to Fox News Digital.

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Shapiro, a Democrat and the commonwealth’s former attorney general, prosecuted public assistance-related crimes and now governs the state with the nation’s highest number of criminal convictions for Medicaid fraud.

The governor — who was considered a runner-up to Walz in then-Vice President Kamala Harris’ search for a running mate — said the commonwealth is a "national leader in stopping fraud."

"Here in Pennsylvania, we combat fraud wherever we find it. In 2024, we charged 119 cases of Medicaid fraud — recovering more than $11 million for taxpayers," Shapiro said in a recent statement.

"Governor Shapiro has made fighting public assistance fraud a cornerstone of his career in public service, rooting out waste, fraud and abuse as Attorney General where he cracked down on fraud and public assistance benefit theft, charging dozens of people who stole millions in taxpayer dollars," Shapiro spokeswoman Rosie Lapowsky told Fox News Digital.

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Lapowsky said the Pennsylvania Department of Human Services (DHS) brought one of the cases referenced by McDonald to the Justice Department for further investigation during Shapiro’s tenure.

"[That is] clearly showing our system works," she said, adding that Pennsylvania’s high number of home-care service providers is not by itself an indicator of fraud. Conservative critics in Minnesota and Washington state have pointed to similar provider numbers to raise suspicions about fraudulent activity.

Pennsylvania — the fifth-most populous state, behind California, Texas, Florida and New York — has seen a 20% increase since 2018 in the number of adults in home-care programs, according to DHS.

DHS said it employs "ongoing monitoring," including an electronic visit-verification system, to ensure proper billing and curtail fraud. The department refers potential fraud cases to Republican Pennsylvania Attorney General David Sunday’s office.

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"This criminal conduct is much more than someone ‘working the system’ — the impact is deep and wide-ranging, as every dollar diverted deprives someone in need of care," Sunday said in a statement.

"In collaboration with our partners, my office last year convicted more than 100 defendants, and clawed back more than $40 million that was intended for Pennsylvanians in need."

In 2025, Sunday’s office handled 744 referrals from DHS alone, according to Harrisburg sources.

Smucker said all stakeholders must continue being vigilant for both Medicaid and Medicare-related fraud.

"People like the four seasons here," he said, referring to the high number of retirees who call Amish Country home.

"But we have a lot of people who are relying on these programs… and we have seen fraud across the system in federal programs. This is probably hundreds of billions per year that is being siphoned-off from taxpayer dollars," he said.

Pennsylvania officials say investigators continue to make progress fighting Medicaid fraud....

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