Attorney General Jackson touts Medicaid fraud unit’s record before legislative committee

North Carolina Attorney General Jeff Jackson appeared before the General Assembly’s House Select Committee on Oversight and Reform to highlight his Medicaid Investigations Division’s efforts to find, investigate, and prosecute Medicaid provider fraud, according to a press release from his office.

“Our Medicaid Investigations Division is one of the best in the country and is pioneering new ways to find Medicaid fraud and prosecute criminals,” Jackson said. “We’re going to keep at this work to protect taxpayer dollars for taxpayers’ health care.”

According to the release, the division has recovered more than $1.2 billion in restitution and civil damages since its creation. Between 2019 and 2025, it recovered more than $296 million — the eighth highest among Medicaid Fraud Control Units nationally — and returned $6.28 for every dollar of federal funding received, the fourth highest recovery rate in the country and nearly double the national average of $3.39.

Jackson also highlighted the division’s data mining program, which reviews federal Medicaid claims data to identify billing irregularities. North Carolina was among the first states to receive federal permission to mine Medicaid claims data for potential fraud. Since 2017, the effort has produced 68 investigations, six criminal convictions with more than $27 million in ordered restitution, and 18 civil False Claims Act settlements with more than $10 million in ordered restitution and penalties.

Recent enforcement highlights cited in the release include a $12.7 million fraud scheme involving five defendants sentenced to between two and six years in prison each; a $2.4 million restitution order against the co-owner of a company that submitted fraudulent claims for incontinence products; and an $8.8 million settlement with Bethany Medical Center and its founder over allegations of medically unnecessary urine drug tests billed to Medicare, Medicaid, and TRICARE.