OPINION:
When scammers abuse federal programs, they are not stealing from some faceless government account. They are pickpocketing hardworking taxpayers and vulnerable patients who depend on these programs.
It happens every single day, and if you think it doesn’t impact you, you’re sorely mistaken.
In fiscal year 2025, federal agencies reported roughly $186 billion in improper payments across 64 programs. Since 2003, improper payment estimates have totaled about $3 trillion — an absolutely staggering amount that could have gone toward serving Americans in need, not lining the pockets of fraudsters.
President Donald Trump was right to wage an aggressive war on fraud, establishing the Task Force to Eliminate Fraud in March under the chairman, Vice President J.D. Vance, to coordinate a national strategy against fraud, waste and abuse in federal benefit programs.
As part of this broader crackdown, the Department of Justice recently announced charges against 455 defendants, including 90 doctors and other licensed medical professionals, in healthcare fraud schemes totaling more than $6.5 billion. That’s equivalent to burning over $740,000 every hour for an entire year. As a pharmacist, I’m sickened to see medical professionals who, instead of fulfilling their role to improve the nation’s health care system, use their insider knowledge to exploit the system.
One of the most disgusting examples is hospice fraud.
I owned and operated an institutional pharmacy that served hospices. I have seen firsthand the good work that honest hospice providers do. It’s supposed to be about comfort and peace for patients at the end of life and for families walking through some of their hardest days.
It takes an especially sick person to exploit dying patients and grieving families for their own benefit. But these fraudsters do it without batting an eye.
At a House Energy and Commerce Committee oversight hearing earlier this year, I raised one example that should shock every American. Auditors found 112 hospice providers operating out of a single physical address. In Los Angeles County alone, hospice agencies likely overbilled Medicare by $105 million in just one year.
One address. 112 hospice providers. If that doesn’t set off alarms, what will?
In response to the widespread fraud, the Centers for Medicare & Medicaid Services (CMS) announced a six-month nationwide moratorium on new Medicare enrollment for hospice and home health agencies, while also suspending payments to approximately 800 hospices and home health agencies suspected of fraud in Los Angeles. They were right to do so.
According to CMS, these providers were responsible for $1.4 billion in Medicare spending last year. That’s a lot of your money being used improperly by bad actors.
Punishment after the fact is important, but it’s not enough. The Trump administration is doing its job and doing it well, but as members of Congress, we must also act to prevent the next wave of fraud before criminals get through the front door.
First, Congress should mandate faster data sharing and automatic reviews when red flags appear. When dozens of providers share the same address, billing patterns spike overnight, or ownership structures recur across suspicious entities, those red flags should prompt immediate scrutiny by the necessary federal, state and Medicaid fraud control units, as well as law enforcement.
Second, Congress should hold states or oversight systems more accountable if they fail to take appropriate measures to prevent the abuse. This is about punishing negligence that severely impairs care and burdens taxpayers. Poor coordination, slow investigations and the ignoring of warning signs enable fraudsters. States and oversight systems that receive or help administer federal dollars must be held accountable when these red flags go unanswered.
Third, every single stolen dollar must be returned by fraudsters, and they should be sent to prison. A slap on the wrist is not enough for criminals who prey on the sick and vulnerable.
Our ultimate goal should be to protect patients and taxpayers. When one scheme works, copycats follow. That is why Congress cannot wait for the next scandal to ask the obvious questions.
President Trump and Vice President Vance are right to put fraudsters on notice. Now it’s Congress’s turn to create proactive, creative solutions to ensure this never happens again.
• Rep. Earl L. “Buddy” Carter (R-GA-01) represents coastal Georgia in the U.S. House of Representatives. A former small business owner and pharmacist by trade, he sits on the House Energy and Commerce and Budget Committees.
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