Pennsylvania Attorney General details his state’s $12 million Medicaid fraud bust
Pennsylvania Attorney General Dave Sunday explains a $12 million Medicaid bust of a Philadelphia pharmacy that allegedly fraudulently collected millions in Medicaid reimbursements for prescriptions it never fulfilled.
FIRST ON FOX: The Trump administration is lifting the hood on federal health benefits programs that cover millions of Americans, ordering insurance carriers to tighten fraud controls as part of a broader crackdown on waste and abuse, Fox News Digital learned.
"Working alongside the White House Task Force to Eliminate Fraud, OPM is taking additional steps to safeguard the premiums paid by federal employees and taxpayers, protect beneficiaries, and ensure health insurance companies are meeting the highest standards of accountability," said Office of Personnel Management (OPM) director Scott Kupor to Fox News Digital.
OPM functions as the federal government’s human resources agency, overseeing civilian personnel policy and administering benefits for federal employees, retirees and their families.
OPM, partnered with the White House Task Force to Eliminate Fraud, is sending new compliance expectations on Wednesday to insurance carriers in the Federal Employees Health Benefits and Postal Service Health Benefits programs, directing them to strengthen fraud prevention, payment reviews, pharmacy benefit oversight, subcontractor accountability, audits and reporting, Fox News Digital learned.
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FEHB cost taxpayers about $70 billion and provided more than 8.2 million federal employees, family members, and other eligible individuals in in 2024. (Jeffrey Greenberg/Universal Images Group via Getty Images)
The push also targets pharmacy benefit managers, the drug-pricing middlemen that administer prescription drug benefits for health plans and negotiate with drugmakers and pharmacies.
The FEHB program cost the government and enrollees about $70 billion in fiscal 2024 and covered more than 8.2 million federal employees, family members and other eligible individuals, according to the U.S. Government Accountability Office.
"OPM is a valuable partner and leader on the Task Force. The steps taken today will protect taxpayers and our federal workforce," White House Task Force Executive Director Scott Brady told Fox News Digital.
OPM is also building a data science and audit team with the agency’s inspector general to review anonymized claims data and detect fraud, waste and overbilling more proactively.
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The White House Task Force has amped up its fraud investigations narrowing in on medical corruption. (Oliver Contreras / AFP via Getty Images)
The Government Accountability Office said in a July 2025 report that OPM should do more to manage fraud risks in the FEHB program, citing risks including benefit card sharing, improper inducements, insufficient or fraudulent documentation, kickbacks, marketing fraud, theft of personally identifiable information, provider ineligibility and self-referrals.
The announcement marks the latest crackdown in medical programs following the launch of a nationwide probe into Medicaid.
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OPM has given orders to insurance companies handling federal employee health benefits to launch investigations into payments, pharmacy benefit oversights, and subcontractors. (Eric Thayer/Bloomberg via Getty Images)
CMS directed all 50 states to submit plans to revalidate high-risk Medicaid providers, including providers subject to less rigorous enrollment standards or operating without a National Provider Identifier in April.
Vice President JD Vance, who is leading the task force, amplified the call in May, saying during a news conference that states could lose federal funding if they fail to aggressively pursue Medicaid fraud.
The push comes amid heightened focus on large-scale fraud cases, including Minnesota’s $250 million "Feeding Our Future" scheme, which became a national flashpoint in recent months.
