Jackson, Sangvai defend NC Medicaid fraud enforcement before House oversight panel
North Carolina Attorney General Jeff Jackson and Health and Human Services Secretary Dev Sangvai appeared before a House oversight committee Thursday as Republican lawmakers pressed state officials over fraud, waste and abuse in the Medicaid program and questioned whether existing safeguards are keeping pace with the program’s size and cost. The hearing put one of the state’s largest spending areas under a sharper political spotlight as lawmakers weigh broader budget demands and oversight priorities.
The House Select Committee on Oversight and Reform announced ahead of the hearing that Medicaid spending in North Carolina is about $36 billion and said enrollment is growing faster than the state’s population. The committee also pointed to rising spending on Applied Behavior Analysis therapy and said members had concerns about how fraud, waste and abuse are being monitored. “The soaring costs for Medicaid are unsustainable for our taxpayers,” committee Chair Grant Campbell, a Cabarrus County Republican, said in a statement released before the hearing. “It leads us to question how those in charge are doing their jobs. And if they’re not policing waste, fraud, and abuse, how realistic is the governor’s $1.1 billion funding request?”
Jackson used the hearing to highlight the work of the Department of Justice’s Medicaid Investigations Division, the state’s Medicaid Fraud Control Unit. In a release issued Thursday, Jackson said the division is “one of the best in the country and is pioneering new ways to find Medicaid fraud and prosecute criminals.” He added, “We’re going to keep at this work to protect taxpayer dollars for taxpayers’ health care.”
According to Jackson’s written testimony and the DOJ release, the division recovered more than $296 million between 2019 and 2025, ranking eighth nationally among Medicaid Fraud Control Units. Jackson said the unit recovered about $6.28 for every federal dollar it received during that span, the fourth-highest recovery rate in the nation, and has recovered more than $1.2 billion in restitution and civil damages since it was created. His testimony said the division currently has 67 employees and has benefited from 15 new positions funded by the General Assembly over the past two fiscal years.
Jackson also pointed to the division’s use of data mining to proactively identify suspicious billing patterns instead of relying only on referrals. His testimony said those efforts have produced 68 investigations since 2017, along with six criminal convictions totaling more than $27 million in ordered restitution and 18 civil False Claims Act settlements totaling more than $10 million in restitution and penalties. The DOJ release said data mining also led to the office’s largest criminal conviction this year, a $12.7 million case involving five defendants.
Sangvai’s department, meanwhile, posted a release before the hearing saying he and Jackson would update lawmakers on “NC Medicaid’s work to identify and address fraud, waste, and abuse.” The department’s written materials submitted to the legislature said NC Medicaid had 114,454 enrolled providers in 2025 and described multiple layers of screening, compliance monitoring and referrals to law enforcement. According to those materials, the Department of Health and Human Services identified 228 credible allegations of provider fraud in 2025 and said 91 providers referred to the Department of Justice were under active investigation as of Feb. 28.
The hearing did not by itself change Medicaid policy, but it underscored how closely lawmakers are scrutinizing the program as they debate future spending and oversight. It also signaled that fraud enforcement, provider oversight and the size of the governor’s Medicaid-related funding requests are likely to remain part of the larger budget fight this session.
Editor’s note: This article was drafted with the assistance of artificial intelligence and was reviewed and fact-checked by a member of the NC Political News editorial team before publication.
