Understanding the Role of Medicaid Fraud Control Units (MFCUs)
This brief describes the role of Medicaid Fraud Control Units (MFCUs) in program integrity efforts, examines caseload and case outcome data, and current issues facing MFCUs.
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KFF Health Tracking Poll: Public Views on Fraud in Government Health Programs
Poll FindingAs the 2026 midterms approach, health care costs remain voters' top health priority, but fraud in government health programs, including Medicaid and Medicare, is resonating with Republican voters, 55% of whom say it's extremely important for candidates to address. Most voters say there is at least “some” fraud in government health programs, but larger shares say there is fraud in the tax system, defense, and foreign aid, while the smallest share sees fraud in the…
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Poll: Costs Are the Top Health Care Issue for Voters in the Midterms, But Fraud Tops Republicans’ List As Trump Administration Pushes Crackdown
News ReleaseHealth care costs top the list of voters’ health care priorities for the midterm elections, though more than half of Republican voters say it is extremely important for candidates to discuss the issue of fraud in government health programs, according to a new KFF Health Tracking Poll. Most voters say there is at least “some” fraud in government health programs, but larger shares of voters see fraud in the tax system, defense, and foreign aid…
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Medicaid Program Integrity: Tracking State-Specific and Nationwide Federal Action
TrackerThis page tracks emerging developments in the federal government’s approach to Medicaid program integrity, along with the implications of those actions for different states.
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What to Know About Recent Federal Actions Involving State Medicaid Program Integrity
Issue BriefThis brief describes recent HHS actions (state-specific and nationwide) related to Medicaid program integrity and outlines some open questions about the future of Medicaid program integrity, including which states might become a focus of administration effort.
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CMS’ New Approach to Federal Medicaid Spending in Cases of Potential Fraud
Issue BriefCMS is taking a new approach to fraud that will rely more heavily on options to pause or withhold significant amounts of federal funding in cases of potential fraud, which could have broad implications for states and enrollees. This issue brief explains the new approach.
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Medicaid Financing: The Basics
Issue BriefMedicaid represents $1 out of every $5 spent on health care in the U.S. and is the major source of financing for states to provide health coverage and long-term services and supports for low-income residents. This brief examines key questions about Medicaid financing and how it works.
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Understanding Medicaid Home Care Amid CMS Focus on Potential Fraud and Abuse
Issue BriefThis issue brief describes how Medicaid home care operates—including who is eligible and the systems in place to promote program integrity in its delivery—and the challenges of using new CMS data to identify unusual billing patterns or potential fraud in the program.
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What Newly Released Medicaid Data Do and Don’t Tell Us
Policy WatchOn February 14, 2026, CMS released a dataset with provider-level spending data that the agency suggests could be used to identify unusual billing patterns for specific services, states, or providers. This policy watch describes what the data include, what they exclude, and how they could potentially lead to mistaken conclusions given the limitations of the data.
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Examining the Potential Impact of Medicare’s New WISeR Model
Issue BriefOn January 1, 2026, the Center for Medicare & Medicaid Innovation (CMMI) launched the Wasteful and Inappropriate Service Reduction (WISeR) Model that establishes new prior authorization requirements in traditional Medicare. This analysis explores the potential impact of the WISeR model by examining recent spending and utilization trends in traditional Medicare for services selected for prior authorization requirements in the six model states (Arizona, New Jersey, Ohio, Oklahoma, Texas, and Washington).