SC solicitor running for attorney general calls for stricter oversight of Medicaid applications

COLUMBIA — A solicitor running for attorney general said Wednesday he would use the office to push for legislation giving the state’s top prosecutor more power to go after Medicaid fraudsters.

The calls from David Stumbo, who’s competing in a three-way race June 9 for the GOP nomination, come amid increased scrutiny nationwide on allegations of fraud in government-funded assistance programs. It’s a uniting issue for Republicans, including his primary opponents.

After claims of Medicaid fraud in Minnesota, which led to charges against 15 people accused of stealing more than $90 million, the Trump administration in March created a task force focused on eliminating improper payments of government assistance.

Feds announce charges in ‘unprecedented’ Medicaid fraud scheme in Minnesota

South Carolina isn’t among the states the administration has pointed to as examples of rampant fraud.

But “South Carolina is not immune from this,” Stumbo told reporters at a Statehouse news conference hours before a televised debate in the attorney general’s race.

“We don’t want to be the next national scandal when it comes to abuse of Medicaid dollars,” he continued.

The state participated in a national investigation billed as the largest in history, which resulted in charges last year against 11 people accused of defrauding taxpayer-provided health care programs in South Carolina by more than $23 million.

Stumbo, the chief prosecutor for Abbeville, Greenwood, Newberry and Laurens counties, pointed to numbers from data analysis company LexisNexis that he claimed shows thousands more South Carolinians could be receiving Medicaid payments who shouldn’t.

The state’s Medicaid agency, however, said the data he used was inaccurate.

Stumbo complimented Attorney General Alan Wilson’s work prosecuting people receiving improper payments.

The attorney general’s office has two offices dedicated to investigating Medicaid fraud, one for recipients and one for providers.

The unit that looks into Medicaid recipients, which has five investigators and two attorneys, works with the Department of Health and Human Services, which oversees the Medicaid program, to uncover and prosecute fraud cases, said attorney general’s office spokesman Robert Kittle.

During 2025, the office’s work resulted in more than $535,000 paid back to the state Medicaid agency from improper payments. The office had 254 investigations pending at the end of 2025, Kittle said.

Stumbo says the office needs more tools to further investigate fraud and send people found guilty to jail for longer periods of time. Both of his GOP opponents agree.

11 charged with defrauding taxpayer-funded health care in SC as part of nationwide takedown

That would require change from the Legislature.

A bill the Senate passed unanimously April 15 — which Stumbo said he would advocate for as attorney general — would have given the office more power to request information. It also sought to increase penalties based on how much a person received in illegitimate payments.

Advocacy from Wilson’s office for the bill included helping craft its tiered penalties, Kittle said.

The House never took up that bill, so it died with the end of the legislative session. But Sen. Billy Garrett, the bill’s main sponsor, said he intends to re-introduce the legislation ahead of the 2027 session starting in January. Garrett, a Greenwood Republican, has endorsed Stumbo’s bid to be attorney general.

Stumbo, of Greenwood, also said he would ask legislators for money to expand the number of attorneys working on Medicaid fraud cases and buy technology, potentially using artificial intelligence, to evaluate whether everyone on the rolls should be getting the government assistance.

What Stumbo’s opponents said

Stumbo’s opponents in the GOP primary, Sen. Stephen Goldfinch and Solicitor David Pascoe, said they also intend to prosecute Medicaid fraud to the fullest extent if they win.

Goldfinch, of Murrells Inlet, is a co-sponsor of the bill, which he called a good piece of legislation. He hadn’t seen the exact numbers Stumbo was referencing Wednesday, he said, but he was in favor of any effort to reduce taxpayer dollars going to people who shouldn’t get it.

“Any fraud we ought to seek out, pursue and prosecute to the fullest extent of the law,” Goldfinch said, adding that he hoped to crack down on other types of insurance fraud as well. “My office would do that with not just Medicaid fraud but any fraud.”

Pascoe, chief prosecutor for Calhoun, Dorchester and Orangeburg counties, said he felt the existing attorney general’s office should be investigating and prosecuting more cases, since fraud appears to continue happening.

“Any time we get additional tools to combat corruption, I am for it,” said Pascoe, who lives in St. Matthews. “I also worry Medicaid fraud is rampant in South Carolina because of the lack of prosecution that we have in Medicaid fraud.”

Incomplete data

The amount of fraud Stumbo pointed to Wednesday to prove his point, however, was overblown, the state’s Medicaid agency said.

The data came from LexisNexis, which helps determine whether Medicaid applicants are eligible. Garrett asked for information on people enrolled in May 2025 in a Medicaid program specifically for people with a disability or older than 65 who had more money than they should to qualify.

Single applicants to the program are allowed to have no more than $9,950 in their bank accounts to receive payments under the program, while married couples can’t have more than $14,910, according to the agency.

“Medicaid is for sick kids. It’s for grandmothers. It’s for those that are poor and need the services, not for millionaires, not for fraudsters,” Stumbo said.

LexisNexis reported that at least 9,316 people had more than the amount of money allowed under the Medicaid program, according to a report provided to reporters. Of those, 1,056 had between $100,000 and $1 million, according to the report. Two had more than $1 million. Because of health care privacy laws, the report did not include names.

Stumbo estimated that means $147.2 million was improperly paid.

“This is not accurate,” Eunice Medina, director of the state’s Medicaid agency, wrote in a letter to Garrett last June.

Garrett and Stumbo acknowledged their estimate relied on incomplete numbers.

Most of the people in the LexisNexis report aren’t in the health care program because the agency determined they don’t qualify, Jackson Wilkens Burnaugh, spokeswoman for the Medicaid agency, told the SC Daily Gazette on Wednesday.

Of the nearly 10,000 applications flagged as possessing more than $10,000, most were denied entry. Nearly 1,700 were later found eligible and admitted, and close to 600 were removed from the rolls for not meeting the criteria, Medina wrote in her letter to the senator.

“I want to be clear that information submitted to you by LexisNexis positing an annual cost avoidance of $147.2 million in our state’s Medicaid program incorrectly assumes SCDHHS wrongly enrolled each individual LexisNexis flagged,” Medina wrote in the letter, provided Wednesday to the Daily Gazette.

In the report, LexisNexis noted it does not receive additional information about the applications, including whether they are new applications or regular checks of verification. The company also does not know whether a person is filing as an individual or part of a couple, meaning some might have been within their limits depending on their type of application.