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Pennsylvania AG Says Teamwork Drives State’s Lead in Medicaid Fraud Convictions

Pennsylvania Attorney General Dave Sunday says aggressive prosecution, early detection and cooperation between state and federal agencies helped make Pennsylvania one of the nation’s leading states for Medicaid fraud convictions.

In an interview with Fox News Digital, Sunday said his office treats Medicaid fraud as both a taxpayer issue and a public-safety issue. He argued that money intended for vulnerable patients should not be diverted by fraudulent providers, criminal enterprises or people who bill for services that were never delivered.

Pennsylvania’s Medicaid Fraud Control Section reported the highest number of criminal convictions in the country for fiscal year 2025, according to the state attorney general’s office. The ranking comes as Medicaid fraud has become a larger national focus, with federal officials and several states increasing attention on health care billing schemes, patient neglect cases and social service fraud.

“We have an absolute moral duty to protect the most vulnerable amongst us,” Sunday told Fox News Digital, arguing that the state must make sure resources meant for Medicaid recipients actually reach them.

TRENDING TODAY

The national numbers show why states are paying attention. The HHS Office of Inspector General reported that Medicaid Fraud Control Units across the country secured 1,185 convictions in fiscal year 2025. Those cases included 856 fraud convictions and 329 convictions involving patient abuse or neglect. The report also said Medicaid fraud units recovered $4.64 for every dollar spent by state and federal governments.

Sunday said Pennsylvania’s success is based on collaboration. He pointed to cooperation between his office, Democratic Gov. Josh Shapiro’s administration, the Pennsylvania Office of State Inspector General, service providers, federal partners, local agencies and other attorneys general around the country.

That approach matters because Medicaid fraud cases can be complicated. Some involve local providers submitting false bills. Others may involve multistate organizations or networks that move money across state lines. Sunday said investigators must share information quickly because criminal groups do not limit themselves to one jurisdiction.

The attorney general also said Pennsylvania is trying to prevent large fraud networks from becoming established in the first place. He contrasted that approach with states that have faced major alleged fraud schemes involving large sums of Medicaid money.

One major case highlighted by Sunday involved Broad Street Family Pharmacy in Philadelphia. State prosecutors said people connected to the pharmacy submitted fraudulent Medicaid claims for expensive medications, including HIV drugs and antipsychotic medications. Prosecutors said some of the medications were allegedly never obtained or provided to patients.

Two alleged ringleaders in that case, Peter Dello Buono and Frank Bengermino, were sentenced to prison terms and ordered to pay more than $12 million in restitution, according to Sunday’s office and media reports. Sunday argued the case showed why fraud prosecutions can return major sums to taxpayers while also stopping providers from continuing unlawful billing practices.

Sunday also emphasized that his office does not only pursue financial fraud. Medicaid fraud units also investigate abuse and neglect involving patients who rely on Medicaid-funded care. These cases can involve nursing homes, personal care homes, home health services and other providers responsible for vulnerable people.

One case he referenced involved Kelly R. Gonzalez, a personal care administrator convicted after a resident went without prescribed seizure medication and later died. Sunday described abuse and neglect cases as some of the most difficult cases prosecutors see because they involve people who depend on others for basic care and medical treatment.

The broader political context is also important. The Trump administration has made waste, fraud and abuse in federal programs a major priority. Reuters reported this week that HHS moved to cut federal funding to Hawaii’s Medicaid Fraud Control Unit after the state failed to consistently bring criminal cases over several years, showing that federal officials are pressuring states to prove results.

Pennsylvania, meanwhile, is presenting itself as a model for aggressive enforcement. Supporters say the state’s approach shows that Medicaid fraud enforcement can be bipartisan, with Republican and Democratic officials working together to recover money and protect patients.

Critics of aggressive fraud crackdowns sometimes warn that enforcement must be careful not to punish providers for paperwork mistakes or discourage legitimate care. But Sunday’s office says the focus is on serious fraud, intentional deception, neglect and abuse.

As Medicaid costs remain a major part of state and federal budgets, fraud enforcement is likely to stay in the spotlight. Pennsylvania’s ranking gives Sunday and other state officials a chance to argue that early reporting, strong referrals and coordinated prosecution can produce results.

Why It Matters

Medicaid is designed to help low-income Americans, seniors, people with disabilities and vulnerable patients receive care. When providers or criminal groups steal from the program, taxpayers lose money and patients may be denied services they need.

Pennsylvania’s results also matter because federal officials are increasing pressure on states to show they are actively investigating and prosecuting Medicaid fraud.

What Comes Next

Pennsylvania officials are expected to continue working with federal agencies, state inspectors and local providers to identify suspicious billing patterns and pursue criminal cases.

Other states may face more scrutiny from HHS-OIG if their Medicaid fraud units fail to bring indictments, convictions or meaningful recoveries. The national focus on Medicaid fraud is likely to grow as Washington pushes harder on waste, fraud and abuse in federal programs.

Ohio Attorney General Dave Yost praised the federal anti-fraud effort, saying Medicaid fraud investigations are receiving unusually strong support.

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