Pennsylvania Governor Josh Shapiro is preparing to unveil a sweeping initiative aimed at aggressively combating fraud within the state’s Medicaid system. This isn’t a new fight for Shapiro, who championed similar efforts during his time as Attorney General, but the issue has gained urgent national attention recently.
The governor will announce his plan during Tuesday’s budget address, emphasizing the critical need for a state False Claims Act. This legislation would empower Pennsylvania to recover misused funds from those who exploit social service programs, and Shapiro has signaled a willingness to collaborate with Republicans – who currently control the state Senate – to make it a reality.
“To protect our kids and our seniors, we need to make sure every dollar we appropriate for their benefit goes to them and doesn’t get fleeced from the system,” Shapiro is expected to declare, drawing on his past successes in prosecuting individuals who stole from public benefit programs.
Pennsylvania already stands out nationally in its pursuit of Medicaid fraud, leading the nation in charges filed and ranking third in convictions. This commitment will be further bolstered by continued support for State Inspector General Michelle Henry and increased cooperation across all state agencies.
In 2024 alone, the commonwealth prosecuted 119 cases of Medicaid fraud, successfully recovering $11 million in stolen funds. Additionally, the Department of Human Services has forwarded 744 suspected fraud cases to the Attorney General’s Medicaid Fraud Control Section for investigation.
The proposed False Claims Act would significantly enhance Pennsylvania’s ability to recoup funds, allowing the state to collect additional money from those convicted of misusing Medicaid or other vital social service dollars. Shapiro’s team notes that this concept already enjoys bipartisan support, echoing calls from previous Republican legislative leaders.
Back in 2020, then-Speaker Bryan Cutler emphasized the urgent need for reforms to safeguard the Medicaid program and ensure resources reach those who genuinely need them. Senator Seth Grove similarly highlighted the burden placed on taxpayers by every fraudulently obtained dollar.
A recent grand jury investigation, initiated during Shapiro’s tenure as Attorney General, laid the groundwork for this announcement. The grand jury recommended stricter regulations, including mandatory registration for providers lacking a national provider identifier and standardized training on proper billing procedures.
These proposed changes also include a requirement for all Medicaid forms to clearly indicate the date and specific times services were provided – information currently not mandated by law. The aim is to create a more transparent and accountable system, minimizing opportunities for abuse.
However, the plan isn’t without its critics. Some, like the Pennsylvania Coalition for Civil Justice, have voiced concerns that a False Claims Act could incentivize frivolous lawsuits and ultimately reduce the amount of funds recovered. They point to Wisconsin’s repeal of its own False Claims Act as a cautionary tale.
Concerns have also been raised by the hospital industry, with some fearing that trial attorneys would disproportionately benefit from the legislation, rather than the patients the system is designed to serve. Despite these reservations, Shapiro remains steadfast in his commitment to protecting taxpayer dollars and ensuring the integrity of Pennsylvania’s vital social safety net.
