Don’t create political theater — fund the Medicaid fraud fighters

With the 2026 election approaching, Gov. Kim Reynolds and Attorney General Brenna Bird have unveiled a new priority: cracking down on Medicaid fraud.

That comes as a big surprise to those of us who know the system and have actually fought Medicaid fraud. Why such a surprise? Because our governor and attorney general have long disregarded the most effective tools already at their disposal to fulfill their pronounced objective.

The real purpose of their newly created “Medicaid Fraud Elimination Task Force,” unveiled with considerable fanfare, appears to be generating political headlines rather than meaningful results.  And, with each new task force meeting streamed to the public, they have concocted a pretext for sustained Medicaid fraud political theater.

For decades, like every other state, Iowa has maintained a Medicaid Fraud Control Unit (MFCU). Ours is housed within the Department of Inspections, Appeals, and Licensing (DIAL), formerly the Department of Inspections and Appeals (DIA). By law, this specialized unit investigates Medicaid provider fraud, patient abuse, neglect, and the financial exploitation of vulnerable Iowans. It works closely with county attorneys and the U.S. Attorneys’ Offices, which prosecute many of the state’s largest Medicaid fraud and health care fraud cases.

One would have expected that during the task force’s first meeting, the director of DIAL and the director of the MFCU, both members of the task force, would have reminded the chair, Bird, of one simple fact: Iowa already has the legal framework, an established Medicaid Fraud Control Unit, with strong federal, state, and local partnerships needed to combat Medicaid fraud.

AG Bird: ‘There is no acceptable amount’ of Medicaid fraud in Iowa

If Bird is now serious about combating Medicaid fraud, she should begin by fulfilling the responsibilities already assigned to her under Iowa law. The Iowa False Claims Act provides that “[t]he attorney general shall diligently investigate” violations of the act and bring appropriate actions. Enacted in 2010, the Iowa False Claims Act remains one of the state’s most effective tools for recovering taxpayer dollars lost through Medicaid fraud.  Rather than chairing a task force, the attorney general should aggressively enforce the law she’s already been directed to implement. Required public reporting by Bird regarding her required False Claims Act efforts reveals a dearth of action.

One area where the False Claims Act requires immediate pursuit is the quality of care provided by taxpayer-funded, for-profit nursing homes. When facilities accept millions of public dollars and profit while failing to provide legally required care, both taxpayers and vulnerable residents suffer. Yet, in 2024, Bird led a coalition of Republican attorneys general challenging the federal minimum nursing home staffing standards rule (a rule researched to save thousands of lives).

Her opposition to those standards, together with other state policy decisions, has coincided with Iowa experiencing a higher rate of nursing home staffing violations than neighboring states.

Iowa’s state auditor also plays an essential role in identifying waste, fraud, and abuse. It is difficult to understand why Iowa’s state auditor was not invited to participate on a task force supposedly dedicated to protecting taxpayer dollars — or perhaps it is not difficult to understand at all. Sand is the state’s lone Democratic statewide officeholder and a candidate for governor in 2026.

Rather than limiting the auditor’s ability to conduct independent oversight, Reynolds and Bird should welcome rigorous audits and public reporting that strengthen accountability throughout Iowa’s Medicaid program.

Further, regarding the actually appointed members of the task force — instead of seating Iowa’s money-making managed care organizations, Iowa should be demanding detailed reports on their fraud detection systems, payment integrity programs, provider audits, and other MCO efforts to prevent improper Medicaid payments.  Accountability — not another task force — is what protects taxpayers.

Our perspectives come from firsthand experience. Kevin Techau served as United States Attorney for the Northern District of Iowa, where he worked alongside the Medicaid Fraud Control Unit and federal investigators to prosecute health care fraud. Earlier, he served as director of the Iowa Department of Inspections and Appeals, overseer of MFCU, and later as commissioner of the Iowa Department of Public Safety.

Dean Lerner served for 16 years as an Iowa assistant attorney general and thereafter, for nearly a decade, as deputy, then director of the Department of Inspections and Appeals. He, likewise, oversaw Iowa’s MFCU. Later, he served as the Northern District’s Health Care Fraud Specialist. We know firsthand that Iowa already possesses the legal authority and strong federal, state, and local partnerships needed to effectively combat Medicaid fraud.  What’s been missing is this administration’s true commitment to that effort.

The warning signs of this administration’s lack of total commitment have been evident for years. In 2022, the Department of Health and Human Services Office of Inspector General issued its multiyear inspection report of Iowa’s MFCU, finding “…that the unit did not maintain staffing levels in accordance with its approved budget, maintained low staffing levels in relation to State Medicaid expenditures, and experienced significant turnover of investigators and high caseloads.”

MFCU staffing is measured by several criteria: whether it is in accordance with the MFCU’s budget, its relationship to the state’s Medicaid expenditures, turnover, and caseloads are among the factors. Iowa’s then-DIA Director Larry Johnson responded to the OIG Report on June 7, 2022, stating that Iowa’s nine employees, with two vacant investigator positions, “…are adequate at this time to operate effectively and efficiently.”

In 2024, Iowa Capital Dispatch Deputy Editor Clark Kauffman reported on a new OIG Report and noted, among other items: “[f]ederal data indicates Iowa’s staffing issue dates back several years,” adding that “[a]lthough Iowa’s unit was approved for 11 employees in the years 2019, 2020, and 2021, it actually employed seven or eight individuals at the end of each of those years.

“Even if all of the vacant positions were filled, the inspector general reported, the Iowa unit’s staffing levels remained low compared to all other fraud-control units in the nation,” Kauffman reported.

In 2025, according to the National Association of Medicaid Fraud Control Units, Iowa spent just $1.3 million on its 10-person fraud unit while overseeing a Medicaid program exceeding $8.7 billion. Arkansas, with a similarly sized Medicaid program, invested approximately $3.9 million in its 23-person fraud unit. Kansas employed 16 staff members and spent approximately $2.2 million to oversee its Medicaid program of roughly $6.5 billion. It doesn’t take a task force to know that proper staffing will yield maximum results.  Iowa’s excuses are just that, excuses.

Medicaid Fraud Control Units investigate providers who bill for services never performed, create phantom patients, up-code claims, perform unnecessary procedures, commit pharmacy and home health fraud, engage in kickback schemes, or abuse and neglect vulnerable Medicaid recipients. Cases are developed through whistleblowers, patients, employees, audits, sophisticated data analytics, and referrals from state and federal agencies — not by another executive order creating a task force.

Investing in MFCU staff is one of the best bargains in government.  For every 25 cents Iowa invests in its MFCU, the federal government contributes 75 cents. Nationally, Medicaid Fraud Control Units recover roughly $3 to $5 for every taxpayer dollar invested. Few public investments generate a better return.

If our honorable governor and attorney general are truly serious about protecting taxpayers and vulnerable Iowans, the task force should meet one more time, adopt the following recommendations, and then disband without further grandstanding.

Fully fund Iowa’s Medicaid Fraud Control Unit with sufficient numbers of highly qualified investigators and staff.

• Aggressively enforce the Iowa False Claims Act.
• Modernize investigative technology and data analytics.
• Restore and promote a rigorous statewide Medicaid Fraud Hotline.
• Empower — not sideline — the state auditor and other independent oversight agencies.