When federal prosecutors unsealed charges against 19 people in Philadelphia earlier this month, the details read like a crime novel: a purported home-care aide billing for round-the-clock care while actually incarcerated, a father-and-son duo charging for services the son never provided because he was driving for a rideshare app—or getting cited for marijuana possession during a traffic stop, or attending a relative's sentencing for another fraud case. One defendant billed while vacationing in Saudi Arabia; another bragged that home care was "the best kept secret," pocketing roughly $500,000 over five years without detection.
The schemes are hardly unique—con artists operate everywhere. What sets Pennsylvania apart is the response. Both Republicans and Democrats in Harrisburg reacted with outrage, not defensiveness. Rep. Lloyd Smucker (R-PA), whose district includes many Medicaid and Medicare enrollees, welcomed the federal task force and called the fraud "criminal activity that is taking money from individuals who really need it." Gov. Josh Shapiro, a Democrat and former attorney general, has touted his prosecutorial record, noting 119 Medicaid fraud cases charged and more than $11 million recovered in 2024 alone. Republican Attorney General David Sunday's office convicted over 100 defendants last year and clawed back more than $40 million.
This bipartisan consensus stands in stark contrast to Minnesota, where a U.S. Attorney has estimated that up to half of the $18 billion spent on Medicaid-funded programs since 2018—potentially $9 billion—may be fraudulent. That follows the $250 million looted from the Feeding Our Future child-nutrition program. Federal officials have frozen over $1 billion in Medicaid payments to Minnesota and California while investigations proceed. Gov. Tim Walz (D) faced months of questions about why his administration kept the money flowing despite red flags, and he was ultimately pressured into retirement.
Pennsylvania's success isn't glamorous: it relies on electronic visit-verification systems and cross-checks against death records and wage data. These are the boring internal controls that catch thieves before they book flights to Riyadh. As any fiduciary expert will tell you, fraud thrives when oversight is merely on paper, never tested.
Yet Pennsylvania's own house isn't fully in order. The state House passed a False Claims Act in July 2025 that would allow whistleblowers to sue on the state's behalf and qualify for a federal bonus on fraud recoveries—money Pennsylvania currently forfeits. The bill never became law, stripped from the final budget package after lobbying by hospital and business groups. Their concerns about speculative lawsuits are legitimate, but the answer is to add guardrails, not kill the bill. States like New York and Texas have effective whistleblower statutes with real intent standards and penalties for bad-faith suits.
Congress could incentivize reform by tying a portion of federal Medicaid administrative funding to states that adopt robust whistleblower laws, similar to the Deficit Reduction Act's bonus for states that mirror the federal False Claims Act. As the anti-fraud push gains momentum, Pennsylvania's example shows that accountability can transcend partisanship. The state's willingness to prosecute and publicize fraud is laudable, but the real scandal is that some states, like Minnesota, spent years explaining away billion-dollar shortfalls. That deserves far more attention.
In the end, the lesson from Philadelphia is clear: fraud schemes survive only as long as those responsible for watching decide to look the other way. Pennsylvania chose to look, and both parties agreed. That should be the baseline for every statehouse in the country.
