Medicaid fraud task force recommends more staff, utilizing false claims act

Iowa’s Medicaid Fraud Elimination Task Force is sending a draft of recommendations to Gov. Kim Reynolds that suggests the state more than double the fraud investigation and civil enforcement unit to hold fraudsters accountable. 

The task force, which was initiated by Reynolds in July, met for the final time Tuesday and outlined their findings on how to end instances of fraud in the tax-payer supported healthcare system. 

Former state officials who have been vocally opposed to the task force said Tuesday that the initiative was “political theater” and that the conclusions it came to were the same recommendations the former officials suggested months ago. 

Kevin Techau, former Iowa Department of Inspections, Appeals and Licensing director, said Attorney General Brenna Bird, who led the task force, could have long ago directed her staff to pursue cases under a state law that allows for lawsuits against parties who have defrauded the state. 

Techau said Bird and Reynolds have been “sitting on their hands” instead of directing staff to file claims under the state’s civil False Claims Act, which he said other state attorneys general have used to pursue cases of fraud and failure to provide Medicaid-funded healthcare.

“Suddenly, they wake up, just before an election, and decide Medicaid fraud is a big issue,” Techau said. “…So, hallelujah! They finally found the answers, but the answers were always sitting there right in front of them.”

Techau said Iowa nursing homes continue to collect Medicaid funds without providing the care they promise. A recent review of Center for Medicare and Medicaid Services data revealed that Iowa had more insufficient staffing citations at nursing homes in 2025 than any other state.

The task force recommended, according to an executive overview released Tuesday, establishing a “civil fraud team” in the Iowa Attorney General’s Office to make use of the Iowa False Claims Act to recover Medicaid funds from fraudsters. 

“Today, Iowa doesn’t have lawyers that are dedicated to suing these Medicaid fraudsters for the money they took, and the task force is recommending a civil fraud team in my office, something I very much support, to use the Iowa False Claims Act to allow triple damages plus penalties,” Bird said during the meeting. 

Recommendations 

In addition to adding a civil fraud team, the task force recommended growing the Medicaid Fraud Control Unit staff from 9 people to 24 people, including “dedicated prosecutors, investigators, data analysts and a nurse investigator.” 

Eric Wessan, solicitor general for the state, said that “person for person, Iowa’s unit brings more criminal cases than any other unit in the country,” but he said the unit has not grown since 2013. Wessan said that while Medicaid spending has grown 129% since 2013, the Medicaid Fraud Control Unit’s budget has grown 31% in the time period.

“The bottom line is simple: Iowa already does more with less than almost anyone,” Wessan said. “With the right tools, the right people, and the right structure, we can do a great deal more yet.” 

The task force also recommended tougher penalties for Medicaid fraudsters and the establishment of a “Medicaid Fraud War Room” to suspend payments to providers within 24 hours when fraud is suspected, and while it is investigated. 

Stephan Bayens, commissioner at the Iowa Department of Public Safety and a member of the task force, said the investment into the investigation and prosecution side of the issue was “much needed.” 

“In at least some of the public comments that we received, there (were) concerns about staffing levels, and I believe that this is an appropriate recommendation to kind of recognize the good work that’s being done, but also recognize there is capacity that could be addressed with more people.” 

Another section of the task force recommendations calls for revalidating high-risk providers and deactivating providers who are not serving patients. 

It recommended increasing technology and analytical tools for the fraud unit and related departments so they can use data to target reviews of high-risk areas such as in-home care to help ensure, for example, that a caregiver actually showed up to provide the care that was billed to Medicaid. 

Wessan said the task force was also recommending a “program integrity technology unit” within the Iowa Department of Health and Human Services to measure what is spent on “fraud-fighting technology” and what the technology has recovered. 

The task force was also directed to investigate ways to enhance fraud awareness and public reporting of suspected instances of fraud. The task force recommended the state release a video that clearly explains Medicaid fraud and how to report it to the state through avenues such as IowaFraudFighters.gov. 

Wessan said some of the recommendations “can start tomorrow under existing authority” but others will require legislative approval or funding. 

Bird said the draft of the recommendations will be submitted to Reynolds who, upon approval of the recommendations, will release the draft to the public. 

Bird thanked the task force for its work over the past several months. 

“Adopting this report, too, I want people to know this is not the finish line,” Bird said. “This is the starting line. Our message today is unmistakable: Iowa has zero tolerance for anybody who would steal from the taxpayers or exploit vulnerable people who are on Medicaid.”