Oversight & Investigations

Subcommittee

Subcommittee on Oversight & Investigations

Responsible for conducting oversight and investigations of any matter related to the jurisdiction of the full committee.

Subcommittees News & Announcements

Aug 5, 2026

Press Release

Chairmen Guthrie and Joyce on the Decertification of Kentucky OPO Following Months of Congressional Oversight

WASHINGTON, D.C. - Today, Congressman Brett Guthrie (KY-02), Chairman of the House Committee on Energy and Commerce, and Congressman John Joyce, M.D. (PA-13), Chairman of the Energy and Commerce Subcommittee on Oversight and Investigations, issued the following statements following the Department of Health and Human Services' (HHS) decision to decertify Network for Hope - the Organ Procurement Organization (OPO) covering Kentucky and parts of Ohio, West Virginia, and Indiana.

"Thanks to the steadfast oversight efforts of Secretary Kennedy and our robust oversight on the House Committee on Energy and Commerce, decisive action has been taken to protect American patients and families," said Chairman Guthrie. "We have conducted rigorous oversight of the alarming practices in our organ procurement and transplantation system, and the American people deserve to have an organ procurement and transplantation system that they can trust. This action takes a step forward in restoring integrity back to that system."

"Serious deficiencies in Network for Hope's organ procurement process were brought to light through the work of our Oversight and Investigations Subcommittee," said Chairman John Joyce, M.D. "Despite subsequent efforts by HHS to address these issues, concerns remain about Network for Hope's ability to safely carry out its duties as an OPO. Therefore, I applaud HHS for taking decisive action to initiate the decertification process against the organization. I want to express my gratitude to Secretary Kennedy, Administrator Engels, and Administrator Oz for their attention to this important issue and their recognition of this necessary action following our oversight efforts, including last year's hearing that centered on our concerns regarding Network for Hope. As the process moves forward, I urge Network for Hope to fully cooperate with HHS to ensure that patients and their safety are prioritized throughout the decertification process and the selection of a new OPO to take over Network for Hope's donor service area."

BACKGROUND:

During the 118th Congress, the Committee on Energy and Commerce led the passage of the Securing the U.S. Organ Procurement and Transplantation Network Act to both modernize the Organ Procurement and Transplantation Network (OPTN) and allow HRSA to institute a competitive contracting process to find the best contractors for various OPTN functions. This legislation was signed into law on September 22, 2023.
On March 20, 2024, the Committee launched an investigation into the organ procurement and transplantation system by sending a letter to United Network for Organ Sharing (UNOS) requesting information related to concerns surrounding data security and operability, patient safety and equity, and conflicts of interest.
On March 20, 2024, the Committee also sent a letter to HRSA requesting information related to implementation of the Securing the U.S. Organ Procurement and Transplantation Network Act as well as other concerns related to effective oversight and management.
On September 11, 2024, the Subcommittee on Oversight and Investigations held a hearing that focused on the implementation of reforms at the OPTN, including the need for stronger oversight and accountability as well as ongoing patient safety concerns.
During the hearing, questions were raised related to allegations of mismanagement and patient safety concerns after patients began exhibiting signs of increased neurologic function after being previously deemed suitable as an organ donation candidate. Several of these allegations, particularly those related to patient safety, were later substantiated through the findings contained in HRSA's March 2025 report.
On March 24, 2025, HRSA's Division of Transplantation issued a report that summarized the findings of its investigation into KYDA, the OPO now known as Network for Hope, which serves Kentucky and parts of Ohio, West Virginia, and Indiana.
HRSA's investigation examined an "index case" and an additional 351 unique cases of authorized, not recovered (ANR) patients. This means that the patients were considered for donation after circulatory death recovery, but no organs were transplanted. The report showed that nearly 30 percent of the cases "had concerning features." The concerning features included problems with patient-family interactions, medical assessments and team interactions, recognition of high neurologic function, and recognition and documentation of drugs in records.
On May 28, 2025, HRSA issued a corrective action plan to the OPTN, which directed the OTPN to take specific actions within a specified period of time, including developing a 12-month OPTN monitoring plan for KYDA to address concerns identified. The corrective action plan also requires the OPTN to propose policies for public comment to improve safeguards for potential donation after circulatory death (DCD) patients in the organ procurement process and increase information shared with patient families regarding DCD organ procurement.
On July 22, 2025, the House Committee on Energy and Commerce's Subcommittee on Oversight and Investigations held a hearing examining concerning practices within our nation's organ procurement and transplant system that were identified by HRSA's investigation.
On September 12, 2025, the Committee sent a bipartisan letter to the HRSA requesting a briefing on its ongoing oversight of patient safety in our nation's organ procurement and transplant system.
On November 17, 2025, Chairmen Guthrie and Joyce sent a letter to CMS requesting a briefing to better understand HHS' recent actions and ongoing work to enhance safety within the organ procurement and transplantation system.

Jun 26, 2026

Press Release

Guthrie: “If you’re cheating the system, we’re going to come after you. If you’re the most vulnerable, you’re going to be taken care of.”

WASHINGTON, D.C. - Yesterday, Congressman Brett Guthrie (KY-02), Chairman of the House Committee on Energy and Commerce, and Congressman John Joyce, M.D. (PA-13), Chairman of the Subcommittee on Oversight and Investigations, continued their fight against fraud in Medicaid programs across the country... while Democrats used our most vulnerable Americans as a political football denying that evidence of widespread Medicaid fraud exists and claiming that Republicans' efforts to combat Medicaid fraud are merely a political exercise.

Even after three hearings held in the Energy and Commerce Committee's Subcommittee on Oversight and Investigations, Democrats still refuse to acknowledge that fraud schemes occurring nationwide within government health programs are real, plentiful, destructive, and in some cases, even lethal.

In January 2026, two individuals pleaded guilty to a seven-year $68 million Medicaid fraud scheme involving two Brooklyn-based social adult daycares (SADC) and a home health company.

On February 19, 2026, the New York State Comptroller "found questionable Medicaid payments, safety risks, and compliance problems" in SADC programs. In another instance, two Queens men who owned SADCs and a pharmacy were charged with $120 million in alleged Medicare and Medicaid fraud schemes.

On April 7, 2026, a California man pleaded guilty to submitting nearly $270 million in fraudulent claims over an 11-month span to California's Medi-Cal program for expensive prescription drugs that were medically unnecessary and, in many instances, not provided to the purported recipients.

In May 2026, then-Ohio Attorney General Dave Yost announced that three individuals had been charged with fabricating home health billing time sheets, billing for services that were not provided, and double billing while working at other jobs. Two of the individuals even billed Medicaid for in-home health services that were not possible-one while a client was hospitalized for four months, and another when the provider was on vacation in Jamaica.

On May 13, 2026, Vice President J.D. Vance announced a deferral of $1.3 billion in questionable or potentially unallowable costs in California's Medi-Cal program, specifying that, "the state of California has not taken fraud very seriously."

On May 21, 2026, the DOJ announced the Minnesota Health Care Fraud Takedown-the largest Medicaid fraud take down in the history of the District of Minnesota-where two individuals perpetrated a $46.6 million scheme to bill for Early Intensive Developmental and Behavioral Intervention services for children with autism that were not necessary or never provided. The defendants allegedly paid kickbacks to parents to enroll their children in autism therapy, facilitated diagnosing children with autism whether or not they in fact had the condition, and billed Minnesota Medicaid for services that were not rendered.

On June 4, 2026, DOJ announced a $30 million Medicaid fraud case, known as "Operation Playground Therapy," where the defendants operated behavioral health services companies that submitted false claims for therapy services for children and young adults. In the course of its investigation, DOJ "seized three bank accounts with $469K in funds and 14 vehicles worth $800K."

In June 2026, a New York $38 million SADC Medicaid scheme involving kickbacks and false billing resulted in the arrest of eight individuals.

DOJ, just a few days ago, announced the 2026 National Health Care Fraud Takedown, which resulted in charges against 455 defendants, including 90 doctors and other licensed medical professionals, for their alleged participation in health care fraud and opioid abuse schemes involving over $6.5 billion in false claims and significant patient harm, including death. Why are Democrats continuing to deny that vulnerable Americans are being harmed by bad actors exploiting critical safety net programs?

There are endless examples of fraud plaguing Medicaid, and billions of taxpayer dollars are lining the pockets of bad actors who are exploiting critical programs. And worst of all, vulnerable Americans are kept from receiving critical and potentially life-saving care. Yet, instead of facing the facts, Democrats continued to double down on their fearmongering tactics. Because unlike Democrats, Republicans believe that fraudsters who use precious taxpayer dollars to buy luxury cars and designer jewelry deserve to be put behind bars.

Republicans make no apologies for working to restore the integrity of a program intended to protect America's most vulnerable: expectant mothers, children, low-income seniors, and individuals living with disabilities. And we will not stop until vulnerable Americans are safeguarded and the Medicaid program and the taxpayer dollars that fund it are used for their intended purpose.

Democrats are gaslighting the American public. Fraud is real. And it's your tax dollars that fund it.

BACKGROUND

On January 20, 2026, Congressman Brett Guthrie (KY-02), Chairman of the House Committee on Energy and Commerce, Congressman John Joyce, M.D. (PA-13), Chairman of the Energy and Commerce Subcommittee on Oversight and Investigations, and Congressman Morgan Griffith (VA-09), Chairman of the Energy and Commerce Subcommittee on Health, requested communications, documents, and information from Minnesota Governor Tim Walz and then-Temporary Commissioner of Minnesota's Department of Human Services, Shireen Gandhi, to better understand the ongoing Medicaid fraud occurring in the state of Minnesota and actions the state is taking to strengthen program integrity.
On February 3, 2026, the Subcommittee held a hearing titled Common Schemes, Real Harm: Examining Fraud in Medicare and Medicaid, hearing from experts about the current state of Medicare and Medicaid fraud.
On March 5, 2026, Chairmen Guthrie, Joyce, and Griffith sent letters to ten additional states-California and New York were among the states to which letters were transmitted-to request information and documents on the actions each state is taking to strengthen Medicaid program integrity.
On March 17, 2026, the Subcommittee held a hearing titled Protecting Patients and Safeguarding Taxpayer Dollars: The Role of CMS in Combatting Medicare and Medicaid Fraud, featuring U.S. Centers for Medicare and Medicaid Services (CMS) Deputy Administrator Kim Brandt, who provided detailed discussion with Members related to CMS' recent actions to improve program integrity in Medicare and Medicaid.
Medicaid is an indispensable lifeline for our nation's most vulnerable populations. In order to ensure that Medicaid is there to continue to support future generations of Americans in need, the Working Families Tax Cuts (H.R. 1) strengthened the program for those who need it most.
Within the Medicaid title of H.R. 1, the House Committee on Energy and Commerce found $806 billion in savings from waste, fraud, and abuse. The Senate version of H.R. 1 will save $1.1 trillion.
CBO has confirmed that on net states will save money from the elimination of wasteful state mandates, which means more money will be available to reinvest in our traditional Medicaid population.

Jun 25, 2026

Press Release

Chairman Joyce Delivers Opening Statement at Subcommittee on Oversight and Investigations Hearing with State Medicaid Directors

WASHINGTON, D.C. – Congressman John Joyce, M.D. (PA-13), Chairman of the Subcommittee on Oversight and Investigations, delivered the following opening statement at today’s hearing titled State Medicaid Program Integrity: Examining Fraud Risks and Oversight Deficiencies.

Subcommittee Chairman Joyce’s opening statement as prepared for delivery:

“Good morning, and welcome to today’s hearing titled, “State Medicaid Program Integrity: Examining Fraud Risks and Oversight Deficiencies.”

“Today’s hearing will examine Medicaid program integrity in four states: Minnesota, California, New York, and Ohio. For the first time in years, State Medicaid Directors are testifying before Congress to share what they are doing to address rampant fraud in government health care programs.

“Let me be clear: fraud is not isolated to these states. As we have discussed in two previous hearings before this Subcommittee, Medicaid fraud is a real problem. It happens in every single state, red and blue, and has been harming patients and draining taxpayer resources for decades.

“In Minnesota, a recent 90-million-dollar Medicaid fraud takedown brought charges in autism therapy services, housing support, home health care, and personal care services. This was just the latest set of charges in ongoing fraud investigations occurring there.

“In California, a man recently pleaded guilty to 270 million dollars in fraudulent prescription drug claims to Medicaid. Earlier this year, charges were filed against 21 suspects for defrauding Medicaid hospice benefits of 267 million dollars.

“In New York, 226 million dollars in social adult day care fraud has been charged in 2026 so far. Millions of dollars have been implicated in non-emergency medical transportation fraud schemes in recent years.

“In Ohio, a 42-million-dollar Medicaid fraud takedown implicated nine defendants in connection with therapeutic behavioral health services for children and young adults. Recently, there were also charges made in connection with hundreds of thousands of dollars in in-home services fraud.

“These fraud schemes harm patients. When services are billed but not rendered to vulnerable Medicaid recipients—who are dependent on this support—the consequences can be severe, and sometimes fatal.

“Elderly and disabled patients in need of in-home care do not receive the help they need to live their lives with dignity. Children who benefit from essential therapies do not receive them. Those who rely on transportation assistance to attend medical appointments miss the preventative care and treatments that they need to stay healthy.

“This morning’s hearing is the culmination of a months-long investigation led by this Subcommittee into Medicaid fraud with the goal of strengthening program integrity. After two hearings, letters to 11 states requesting documents and information, and reviewing over 90,000 pages of documents and information produced to the Committee, it is clear that some states are not doing enough to safeguard the Medicaid program, and gaps remain in program integrity requirements that are opening the door to fraud.

“Thankfully, fraud is finally getting the attention it deserves. I commend this Administration for surging resources to the War on Fraud by forming the Task Force to Eliminate Fraud.

“Additionally, CMS and the Office of Inspector General are leveraging their authorities to hold states accountable when they are not meeting the mark. We are seeing accountability for the first time in a long time. But more remains to be done.

“We can no longer tolerate criminals taking advantage of the Medicaid system. Fraud is not and should not be the cost of doing business. It is preventable and we all have a duty to help rein it in.

“It is no longer sufficient to do the bare minimum. States must rise to the occasion and tackle fraud head-on. Our Medicaid program and the patients that rely on it to be healthy depend on it.

“I want to thank our witnesses for being here today. We look forward to hearing from you and learning more about the steps your state is taking to address Medicaid fraud.”

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Subcommittee Members
(18)

Chairman Oversight and Investigations

John Joyce

Pennsylvania – District 13

Vice Chairman Oversight and Investigations

Troy Balderson

Ohio – District 12

Ranking Member Oversight and Investigations

Yvette Clarke

New York – District 9

Gary Palmer

Alabama – District 6

Dan Crenshaw

Texas – District 2

Randy Weber

Texas – District 14

Rick Allen

Georgia – District 12

Russ Fulcher

Idaho – District 1

Diana Harshbarger

Tennessee – District 1

Michael Rulli

Ohio – District 6

Brett Guthrie

Kentucky – District 2

Diana DeGette

Colorado – District 1

Paul Tonko

New York – District 20

Lori Trahan

Massachusetts – District 3

Lizzie Fletcher

Texas – District 7

Alexandria Ocasio-Cortez

New York – District 14

Kevin Mullin

California – District 15

Frank Pallone

New Jersey – District 6

Subcommittee on Oversight & Investigations

Subcommittees News & Announcements

Chairmen Guthrie and Joyce on the Decertification of Kentucky OPO Following Months of Congressional Oversight

Guthrie: “If you’re cheating the system, we’re going to come after you. If you’re the most vulnerable, you’re going to be taken care of.”

Chairman Joyce Delivers Opening Statement at Subcommittee on Oversight and Investigations Hearing with State Medicaid Directors

Subcommittee Members(18)

Recent Letters

Subcommittee Members
(18)