A Republican-led congressional committee looking into potential fraud in the publicly funded health care program for lower-income people is expanding their investigation to Oregon and several other states.

Last week, the committee sent an extensive list of questions about potential fraud in the Oregon Health Plan, the state’s version of Medicaid, to Gov. Tina Kotek and Liesl Wendt, director of the Oregon Department of Human Services. The letter asked what the state is doing to prevent fraud and requested dozens of details about the management of the Oregon Health Plan, giving state leaders two weeks to respond.

The investigation follows up on reports of Medicaid fraud in Minnesota that Republicans have been highlighting and the Trump administration has used to cut off funds to the state in an unprecedented, more draconian approach that critics have likened to political punishment.

The letter to Oregon leaders was signed by the three Republican chairs of the House Committee on Energy and Commerce, Subcommittee on Oversight and Investigations and Subcommittee on Health. They sent similar requests to nine other states: California, Colorado, Massachusetts, Maine, Nebraska, New York, Pennsylvania, Vermont and Washington state. All of them have expanded coverage of Medicaid under the Affordable Care Act starting in 2014, and except Nebraska, they are either run by Democrats or have strong Democratic leadership.

It’s unclear how Oregon will respond. A Kotek spokesperson told The Lund Report that her office is reviewing the letter, noting that there are 1.4 million people on the Oregon Health Plan. 

And a spokesperson for the Oregon Health Authority, which oversees the Oregon Health Plan, told The Lund Report that Medicaid has multiple layers of fraud protection, including a Medicaid Fraud Control Unit and Office for Program Integrity that coordinate with law enforcement to prosecute fraudsters.  

“We maintain a rigorous investigation process to identify wrongdoing and hold those committing fraud, waste, and abuse accountable,” the health authority said. 

The congressional investigation is part of a Trump administration campaign against Medicaid in general and Minnesota in particular, critics say. Last week, President Donald Trump announced a “war on fraud” led by Vice President JD Vance, along with an announcement that the federal government was withholding Medicaid payments to Minnesota, which is led by Democrats.

The federal government pays for more than 60% of Medicaid, which offers free health care benefits, and states pay for the rest. The program covers about 75 million nationwide, including about 1.3 million in Minnesota, which filed a lawsuit last week to prevent a cut in federal Medicaid funds.

The nine-page letter to Oregon marks the second time in nine months that Republicans have requested information from state leaders about the Oregon Health Plan. Last year, the Trump administration asked for personal information about Oregon Health Plan members as part of its push to track down and deport people from other countries. Immigrants who lack appropriate documentation do not usually qualify for Medicaid. Oregon uses state dollars to provide similar benefits to people who would otherwise qualify except for their immigration status. The administration sought similar information about Medicaid enrollees from several other Democratically led states that have similar programs, including California, Illinois and Washington state.

In their letter last week, the three congressional leaders noted that their investigation stems from alleged Medicaid fraud in Minnesota. “The magnitude of the fraud demands states proactively address (fraud, waste and abuse) in Medicaid programs,” the letter said. It noted that a “swath of criminal schemes” targeting Medicaid included “overbilling, falsifying records, identity theft and phantom claims.” 

“The committee is concerned that your state’s Medicaid programs may be similarly vulnerable to (fraud, waste and abuse) that harms Medicaid enrollees, legitimate providers and taxpayers,” the letter said.

Oregon’s only Republican congressional lawmaker, Rep. Cliff Bentz, is on the House Committee on Energy and Commerce. He did not respond to a request for comment about his colleagues’ fraud concerns.

Letter cited Oregon examples

The letter said that Oregon administers several Medicaid programs at “high risk” for fraud.

“Recent fraud investigations and convictions related to Oregon Health Plan are concerning,” the letter said. 

It cited a case of a mother charged “in a conspiracy” involving Medicaid payments to pay for care of “high-needs patients” and the “falsifying” of a disability claim. It also mentioned a request for an investigation into a sober home operator by Stayton state Rep. Ed Diehl, who’s seeking the Republican nomination for governor. Diehl wrote to Oregon and U.S. judicial authorities last September, seeking an investigation of Uplifting Journey and alleging it ran a home tied to a Venezuelan crime gang, the letter said.

Diehl said in an email to The Lund Report that he’s “absolutely concerned” about fraud in the Oregon Health Plan and that congressional concerns may be related to states that expanded their programs “aggressively” under the ACA.

“We have been very aggressive on expansion,” he said. “We have one-third of our population on Medicaid. And, in my opinion, we are more concerned about getting people covered than we are about making prudent use of the dollars we get.”

Under Democratic leadership, Oregon has tried to expand health insurance coverage to improve health outcomes and cut overall medical costs. Multiple studies have shown that routine preventive care is cheaper in the long run than having people uninsured seek care in emergency departments after their conditions have advanced.

Diehl said that mental health programs in Oregon have been particularly susceptible to fraud in recent years following an expansion of services after the legislative approval of millions of dollars for various programs.

“In order to expand rapidly, I think they took shortcuts,” he said. 

The letter singled out an identity theft case in 2024 involving a woman who defrauded the state’s addiction counseling services. 

“The false claims totaled over $3 million and resulted in $1.5 million in fraudulent Medicaid reimbursements,” the letter said.

The letter also mentioned a case involving overbilling by an urgent care chain that agreed to pay nearly $500,000 in settlement and the recent data breach affecting 5,000 members of CareOregon, which serves Oregon Health Plan members in the Portland area.

“Every dollar stolen from the Medicaid program by fraudsters is taken from children, pregnant women, the elderly  and people with disabilities,” the letter said. “It is the duty of states to design Medicaid programs with adequate fraud control measures and work with CMS to swiftly identify and address vulnerabilities in programs.”

The Oregon Health Authority spokesperson told The Lund Report that state officials also are concerned about how Medicaid works.

“At a time when rising costs, hospital closures and politicization of essential services threaten health coverage for children, seniors and communities across the nation, maintaining trust in public health programs is more important than ever,” the spokesperson said in a statement.

“The examples mentioned in the letter are some of the cases where Oregon has identified fraud and taken action,” the statement added. “The Oregon Health Authority’s Office of Program Integrity takes in approximately 55 to 60 referrals per month. Some of those are unsubstantiated fraud claims, others are credible tips that involve investigations or audits. We also had approximately 250 audits opened in the last two years to look more deeply into billing.”  

Two years ago, the state announced efforts to increase its fraud and abuse enforcement in elder care.

The congressional leaders asked for specific details about the state’s fraud oversight process and the actions it has taken to detect and limit illegal activity. That includes the state’s process for criminal referrals, sanctions, screening and data collection to identify fraud and any improper payments.

The congressional leaders gave state officials until next Tuesday to respond.