Pennsylvania Attorney General reports state led U.S. in Medicaid fraud convictions for 2025

Pennsylvania recorded the highest number of Medicaid fraud convictions in the United States in 2025, according to state Attorney General Dave Sunday. Sunday said the ranking stems from the office's focus on rapid investigation and prosecution of cases. He noted that the state also works with federal, state, and local partners to identify and pursue complaints.

Collaboration with state and federal offices Sunday stated that his office coordinates with Pennsylvania's State Inspector General and Governor Josh Shapiro's administration on case referrals. He added that the approach extends to other states because many schemes cross state lines.

The U.S. Department of Health and Human Services Office of Inspector General ranked Pennsylvania first in total fraud charges filed against individuals for fiscal year 2025 and first in convictions for the same period.

Recovery and case examples Sunday reported that the Medicaid fraud unit recovers $4.64 for every dollar spent on investigations. He said convictions allow the state to obtain restitution that returns funds to taxpayers. In one recent case, nine people were charged in connection with the Broad Street Family Pharmacy in Philadelphia.

Prosecutors alleged the defendants billed Medicaid for up to $12 million in medications that were never obtained or dispensed. Two defendants received prison sentences between 1.5 and five years and were ordered to pay $12.25 million in restitution.

Sunday also said the office prosecutes neglect and abuse cases involving Medicaid recipients in addition to billing schemes.