The House Energy and Commerce Committee released a comprehensive Majority Staff Report on September 29, 2026, detailing systemic fraud within Medicare and Medicaid. The findings, titled “Continuing the Fight Against Fraud,” coincide with the introduction of a 14-bill legislative package by House Republicans designed to tighten oversight and recover taxpayer funds lost to transnational criminal organizations and fraudulent enrollment schemes.
The legislative and executive crackdown follows a 2024 GAO estimate that found the federal government loses between $233 billion and $521 billion to fraud annually across all programs. While the total figure encompasses various federal agencies, the new committee report highlights healthcare programs as primary targets for high-value exploitation.
Legislative Package and Medicaid Oversight
The 14-bill package introduced by House Republicans seeks to shift the federal response from a “pay and chase” model to real-time prevention. A centerpiece of this effort is the HELP STATES Act, which would allow state governments to retain 25% of recovered federal Medicaid overpayments. Under current regulations, states are often required to return the bulk of recovered funds to the federal government; proponents of the bill argue that allowing states to keep a portion will provide the financial incentive necessary to invest in more robust fraud detection technologies.
The scale of the financial risk is particularly evident in large state programs. According to the House Committee on Energy and Commerce, California’s Medi-Cal spending is projected to reach $219.7 billion by 2027, making it a significant focal point for federal oversight efforts.
Other notable components of the 14-bill package include the Anti-Fraud Fund Act of 2026, which aims to modernize auditing software used by the Centers for Medicare & Medicaid Services (CMS). The committee report suggests that current systems are insufficient to track sophisticated transnational schemes, such as “Operation Gold Rush.” This specific scheme, uncovered by the Department of Justice, involved a Russian-linked transnational criminal organization that allegedly billed Medicare for $10.6 billion in fraudulent services.
Executive Actions and Enrollment Audits
The legislative push follows a series of executive actions taken earlier this month. On September 22, 2026, Vice President JD Vance and CMS Administrator Mehmet Oz announced the removal of 760,000 enrollees from the Affordable Care Act (ACA) marketplace.
The Vance-led task force used a five-point criteria to flag these accounts for removal, including:
- Lack of valid Social Security numbers.
- Zero recorded usage of the insurance plan over an extended period.
- Duplicate enrollments across multiple states.
- Inconsistent income reporting that bypassed subsidy thresholds.
- Addresses linked to commercial mail receiving agencies rather than residences.
During recent testimony, HHS Secretary Robert F. Kennedy Jr. addressed the administrative challenges facing these programs. Kennedy reported that program integrity personnel—the staff specifically tasked with identifying and preventing Medicare and Medicaid fraud—were significantly reduced in previous years. He testified that the number of dedicated integrity staff dropped from 80 personnel to just six between 2021 and 2025, a reduction he argued left the programs vulnerable to the multi-billion-dollar schemes detailed in the new staff report.
The House Energy and Commerce Committee is expected to begin markups on the 14-bill package in the coming weeks, while the executive branch continues its audit of remaining ACA and Medicaid enrollment rolls.
