HHS Decertifies Hawaii Medicaid Fraud Control Unit, Cuts Federal Funding
The HHS Office of Inspector General decertified Hawaii's Medicaid Fraud Control Unit effective June 4, 2025, ending federal reimbursement for the unit's operations. Inspector General T. March Bell cited the unit's failure to secure any Medicaid fraud convictions between 2022 and 2025 as the reason for decertification. Hawaii loses access to 75% federal matching funds that support fraud investigation and prosecution activities. This marks a rare enforcement action against a state fraud control unit and signals heightened OIG expectations for measurable fraud enforcement outcomes.
Hawaii MCOs lose a critical fraud investigation partner, potentially increasing plans' exposure to undetected provider fraud and abuse while shifting more program integrity responsibility to health plan special investigations units.
Managed Care
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