Getting to the bottom of it might prevent future losses. Not everything is about politics.
Before another trillion dollars goes out the door, Washington must establish who weakened the safeguards, what warnings were ignored and why obvious schemes went undetected.
Health and Human Services Secretary Robert F. Kennedy Jr. has made an extraordinary allegation about his predecessor, Xavier Becerra. According to Kennedy, HHS had only 80 employees responsible for “program integrity” across 50 states and five territories when Becerra arrived. Becerra then transferred 76 of them elsewhere, Kennedy says, leaving only six people overseeing a department processing some $2.2 trillion in annual payments.
The arithmetic requires clarification, and Kennedy has not yet released the personnel records supporting his claim. HHS also has other fraud fighters, including its inspector general, CMS contractors and state Medicaid enforcement units. Kennedy’s description should not be accepted uncritically.
But what if he is substantially right?
If Becerra transferred nearly an entire program-integrity team away from fraud prevention without replacing its functions, this is no longer an ordinary story about government inefficiency. It could help explain how organized fraud spread across public programs after 2020 — and why governments repeatedly paid claims containing warning signs that should have been visible from space.
Minnesota’s Feeding Our Future scandal resulted in approximately $250 million being stolen from a child-nutrition program. The state’s nonpartisan legislative auditor found that the Minnesota Department of Education failed to act on warning signs and inadequately supervised the nonprofit at the center of the scheme. Investigators subsequently uncovered suspected fraud involving autism treatment, housing assistance and other Medicaid services.
Former federal prosecutor Joe Thompson estimated that Minnesota’s wider losses could eventually exceed $9 billion. That remains an estimate, not an adjudicated loss, but the known cases are already staggering.
California developed similarly improbable patterns. Los Angeles County experienced a 1,500% increase in hospice agencies after 2010. Dozens of separately licensed hospices operated from the same buildings. Some billed Medicare for people who were not dying — or for patients who apparently did not exist.
California’s unemployment system presented another disaster. The state auditor found that officials waited months to strengthen fraud controls during the pandemic, after billions in questionable payments had already escaped. Some estimates placed California’s fraudulent unemployment payments near $30 billion.
Arizona, meanwhile, reportedly lost approximately $2.5 billion through fraudulent addiction-treatment providers and sober-living facilities. Florida, Detroit, Houston and New York have also remained persistent health-care-fraud centers. This is not exclusively a Democratic-state problem. It is a national systems problem.
The common feature is “pay and chase.” Government pays a claim first, then attempts to determine whether it was legitimate. By the time investigators arrive, the money has passed through shell companies, been converted into property or left the country.
Fraudsters learn quickly. They submit a few claims and wait. If the money arrives, they increase the billing, recruit accomplices and open additional companies. One sham hospice becomes 20. One nonprofit claiming fictitious meals becomes an industry. Every successful payment announces that nobody is minding the store.
That is why Kennedy’s allegation requires more than a partisan hearing designed to produce five-minute television clips. Congress should compel the underlying records. The HHS inspector general should conduct an independent investigation, while the Government Accountability Office reconstructs staffing, fraud referrals, payment suspensions and losses before and after the alleged transfers.
The questions are straightforward. Which 80 positions was Kennedy describing? Who were the 76 transferred employees? Where did they go? Did they continue performing fraud-related work? Did contractors replace them? Who approved the reorganization? Were officials warned that it would weaken prepayment controls?
Congress should obtain emails, transfer directives, organizational charts, contractor agreements and internal fraud-risk assessments. Becerra, Kennedy, former CMS administrators and career officials should testify under oath. Their transcribed interviews and supporting exhibits should be placed on the public record.
If the evidence shows that Kennedy exaggerated a routine reorganization, the public deserves to know that too. But if officials removed fraud investigators, ignored internal warnings or disabled safeguards to accelerate payments, that finding must not disappear into the next election.
Bad policy is not necessarily a crime. Neither is reckless management. A criminal investigation would require evidence of bribery, obstruction, false statements, conflicts of interest or deliberate participation in fraudulent activity. That evidence may not exist.
But government failure does not have to be criminal before it becomes historically important.
Washington too often treats investigations as weapons to use against the opposing party. That guarantees that half the country will dismiss the result before the first witness is called. A serious inquiry should have a different purpose: to establish what happened and prevent its repetition.
The money stolen after 2020 was intended for hungry children, dying patients, homeless people and families with disabled children. Recovering it now will be difficult. Learning why it was lost is still possible.
Kennedy has made a specific, testable allegation. It should be tested — with records, sworn testimony and numbers — because another emergency will come. When it does, government cannot once again confuse rapid spending with competent administration and call the resulting fraud a surprise.
(Contributing writer, Brooke Bell)