HHS Inspector General T. March Bell said Hawaii’s Medicaid fraud control unit is no longer certified — and has lost reimbursements from the federal government, as a result.
In a June 4 letter to Hawaii officials, Mr. Bell called out the unit for not securing any Medicaid fraud convictions between 2022 and 2025. The state received about $12 million in federal tax dollars throughout that period.
Mr. Bell also cited the state’s $14 million in recovered civil judgments from 2021 to 2025. He said those recoveries account for less than 0.01% of the state’s Medicaid expenditures. Of the 30 civil cases, 23 were “global settlements” that other entities led, rather than Hawaii’s unit. The remaining cases investigated by Hawaii prompted $11.3 million in recoveries, primarily driven by just one case that brought in $11 million.
In 2021, 2022, 2024 and 2025, the returns on investment based on unit spending were pennies on the dollar, or less, according to the letter. For example, Hawaii spent $2.3 million on these investigations in 2024 but only recovered $10,000.
In that same span of five years, the state issued a single criminal indictment and obtained four convictions for fraud and patient abuse and neglect. That took place in 2021.
In May, a news release from the office of Hawaii Democratic Gov. Josh Green, MD, rejected claims from Vice President J.D. Vance that Hawaii is not serious about these issues.
“The department of the attorney general and the MFCU take Medicaid fraud, patient abuse and neglect very seriously,” Landon Murata, director of the state’s Medicaid fraud control unit, said.
Despite its certification loss, Hawaii has 30 days to request reconsideration. The federal government previously threatened freezes to states’ Medicaid fraud control units under its wider crackdown. The Social Security Act also outlines how broader Medicaid funding could be in jeopardy if the fraud control unit is found to be ineffective.
At the Becker's 5th Annual Fall Payer Issues Roundtable, taking place November 2–3 in Chicago, payer executives and healthcare leaders will come together to discuss value-based care, regulatory changes, cost management strategies and innovations shaping the future of payer-provider collaboration. Apply for complimentary registration now.