Dr. Mehmet Oz Orders States to Strengthen Medicaid Provider Reviews Amid $100 Billion Fraud Estimates

The federal government estimates medical providers fraudulently bill Medicaid for about $100 billion each year. Six months ago, Minnesota made headlines for losing an estimated $9 billion to thieves since 2018.

On April 21, Centers for Medicare & Medicaid Services administrator Dr. Mehmet Oz announced his agency will require states to develop stronger plans to review Medicaid providers. Nationwide, millions of providers participate, and states must revalidate their enrollment at least every five years. This process checks medical licenses and confirms compliance with state and federal laws to block fraudsters.

States have fallen short. The author's organization filed Freedom of Information Act requests with 48 states and the District of Columbia for revalidation data. About two-thirds offered no response, and others sent partial or unhelpful information. Data from responding states revealed a troubling pattern.

Georgia lists 374,774 Medicaid providers, but about 21,000 have not faced revalidation in five years. Illinois has 222,000 providers, with more than 25% overdue by over five years. One Illinois provider skipped checks for more than nine years.

Not every overdue provider commits fraud, but lax enforcement invites it. Revalidation verifies licenses, screens against death records, identifies exclusions and confirms identities. The Trump administration suspended 447 hospices in Los Angeles for fraudulent billing, the type revalidation uncovers.

Revalidation also catches providers banned in one state who bill in another. The author's research in Minneapolis's "Little Mogadishu" complex found providers on Minnesota's exclusion list but not the federal one. One adult day care lost its license over 35 violations, including staff neglect of patients.

A separate Inspector General report showed 12% of providers terminated for cause in one state enrolled in another's Medicaid program months later. In California, scammers used identities of two deceased doctors to bill millions for hospice care. Operation Never Say Die in April 2026 charged individuals for $60 million in fake billings from phantom clinics.

Dr. Oz gave states 30 days to explain improvements. In the early 2010s, Medicare revalidated 1.6 million providers, deactivating over 500,000 and revoking 34,000, which saved $2.4 billion. Better Medicaid revalidation could prevent billions in improper payments today.

States' responses remain unclear. Even with action, the five-year cycle allows bad actors to steal large sums before switching names. The author suggests reviews every few years through regulation or legislation.