California referred few Medicaid fraud cases for investigation: ‘Not even a 50% success rate’

California referred relatively few Medicaid fraud cases for criminal investigation in recent years, as the state has become a hot spot for healthcare fraud, rivaling other fraud-fraught jurisdictions.

Over the past five years, California Medicaid oversight officials referred just a few hundred credible allegations of fraud to California’s Medicaid Fraud Control Unit, the office within the state’s Justice Department that prosecutes fraud cases in its Medicaid program.

Tyler Sadwith, California’s Medicaid director, testified at a House Energy and Commerce Subcommittee on Oversight and Investigations hearing Thursday that his agency forwarded 300 or so such fraud claims during this time to state prosecutors.

“But you said 300 [referrals] and I cited 700,” Rep. Randy Weber (R-TX) pressed, pointing to Sadwith’s written testimony before the committee counting more than 700 cases received by the MCFU over that five-year period.

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“That’s not even a 50% success rate, is it?” Weber asked Sadwith.

“We view the 300 referrals as a strong commitment to California’s rooting out bad actors in our Medicaid program,” Sadwith said.

“That’s a little short of the target,” Weber said, while yielding back with witness questioning.

In a social media statement following the hearing, Weber wrote, “[T]he numbers told the story.”

During today's @HouseCommerce hearing, the numbers told the story.

California's Medicaid Fraud Control Unit received 700 credible fraud allegations over the last five years. Only 300 were referred for investigation.

Would you call that success?

I sure wouldn't.

: @FoxNews x… pic.twitter.com/VT3ScdHVZU

, Randy Weber (@TXRandy14) June 25, 2026

“Would you call that success?” Weber said of California’s referral rate. “I sure wouldn’t.”

Federal investigators have found that fraudulent hospice billing schemes in Los Angeles County alone amounted to $3.5 billion in stolen Medicare dollars and accounted for 18% of all hospice care claims countrywide.

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“Just like [the U.S. Centers for Medicare and Medicaid Services],” Sadwith said at Thursday’s hearing, “we have experienced issues in hospice and have taken comprehensive steps to protect the Medicaid program through new requirements, safeguards, and regulations.”

Sadwith noted that California has criminally charged over 100 suspected fraudsters in the last few years, imposed license moratoriums, revoked hundreds of service licenses, and set up a state hospice task force.