Ads say Aaron Ford isn't doing enough to stop Medicaid fraud. Here's what we found.

Fraud in Medicaid — the sprawling government health insurance program that primarily serves people with low incomes — has been drawing media attention on the national stage. 

And now, it's trickling into the Nevada governor's race. 

President Donald Trump (R) has repeatedly pledged that "we are going to look for fraud" in Medicaid while promising to spare the program from cuts — even as the One Big Beautiful Bill Act is estimated to reduce federal Medicaid spending nationwide by more than $900 billion in the next 10 years. 

Increased scrutiny of Medicaid programs across the country has followed.

In July, the federal government deferred more than $1 billion in Medicaid payments to California and Minnesota as part of its "crackdown on fraud." 

Alongside the national conversation, Nevada's governor candidates have seized on the issue.

When it comes to Gov. Joe Lombardo (R), State Solutions Inc., a dark money nonprofit affiliated with the Republican Governors Association, released an ad at the end of July accusing Ford of "failing Nevada" by not prosecuting hundreds of cases of alleged Medicaid fraud. 

Attorney General Aaron Ford (D) touted in news interviews that his office has brought in more than $40 million in criminal restitution payments to the state's Medicaid system, telling News 3 in early June that his "office has been doing the work, demonstrating that we're going to crack down to protect this critical safety net."

(The head of the attorney general's Medicaid fraud unit later told The Nevada Independent that Ford misspoke and that although Ford did win that money in court, the state hasn't collected it all yet. National data also indicates that Ford's prosecution rate for referred Medicaid cases is twice the national average.)

Read below for an explanation of Medicaid fraud, how the state is addressing it and whether there's truth to the ad's claims that "60 percent of referred cases are gathering dust while fraudsters rip off Nevada taxpayers."

What is Medicaid and how does it work in Nevada?

Medicaid is a joint federal and state program that helps cover medical costs for people on low incomes and those with disabilities. It serves more than 738,000 Nevadans, or approximately 1 in 4 residents. 

Medicaid spending is the single largest expense in Nevada's budget, and an estimated 77 percent of that comes from the federal government.

What is Medicaid fraud?

Medicaid fraud involves intentional deception or misrepresentation to receive improper payments. Fraud can include providers deliberately billing for services not rendered, intentionally diverting funds intended for patient care or knowingly overbilling patients. A KFF policy paper on the issue noted that there is no comprehensive or reliable way to measure fraud in Medicaid because it's only a label that applies after it's been identified. 

Alice Burns, an associate director with KFF's program on Medicaid and the Uninsured, said that research shows most Medicaid fraud is committed by providers, not patients. 

Improper or mistaken payments and processing errors are not fraud, she said. Research indicates that most improper payments stem from missing documentation or administrative steps and are not necessarily for ineligible providers, enrollees or services.

How does Nevada address Medicaid fraud?

Federal law requires that the state's Office of the Medicaid Inspector General report all credible allegations of fraud to the state's Medicaid Fraud Control Unit, which is part of the attorney general's office.

The Medicaid inspector general identifies credible allegations of fraud using data analysis, provider audits, tips, program integrity reviews and other tools. Then it compiles evidence and builds out a case. It then submits those to the Medicaid Fraud Control Unit for criminal prosecution.

The Medicaid Fraud Control Unit independently determines which referrals to accept, then handles criminal investigations, litigation and prosecution to pursue restitution for Medicaid through the courts.

When deciding whether to accept or decline a referral, the Medicaid Fraud Control Unit considers the quality of the referral and the amount of money lost to Medicaid, giving more weight to cases with a greater potential loss. 

The unit must also prove specific intent and must prove the defendant knew what they were doing was wrong. Officials said that if the unit cannot open a referral for a full criminal investigation, it nearly always refers those matters to other agencies that may have the authority to address the situation.

One of those agencies is within the Nevada Health Authority.

In a recent letter responding to an inquiry from a state lawmaker, the Nevada Health Authority said that while Nevada Medicaid can recover only the exact amount of improper payments, the attorney general's Medicaid Fraud Control Unit can seek damages of up to three times the amount paid on a fraudulent claim, in addition to court and attorney costs. 

Is Medicaid fraud a significant issue in Nevada?

Andrew Schulke, chief deputy attorney general and director of Nevada's Medicaid Fraud Control Unit, said that fraud has "really exploded."

It's a problem Nevada Medicaid has highlighted as well.

The prevalence of fraud in the hospice and home-health provider space led Nevada to temporarily pause licensing and Medicaid enrollment for new hospice and home healthcare providers in certain regions of the state in June. The pause came in light of an increase in suspicious billing among Nevada's hospice and home health providers and the state's increased Medicaid spending on certain services. 

"Medicaid fraud is a national problem, and when it happens, it's unfortunately significant in size — often millions are lost in taxpayers dollars from a few bad actors," Stacie Weeks, the Nevada Health Authority director, wrote in a statement. "The good news is … most of our providers in Nevada are good actors."

Officials with the Nevada Health Authority said Nevada Medicaid processes millions, if not billions, of dollars in claims every year from hundreds of thousands of providers, making upfront screening for fraudulent activity tricky.

Fraudsters, officials said, have historically exploited the delay between claims payment and detection, as well as limited staffing capacity.

The state recently upped its game with a new tool from Pulselight that can review Medicaid billing claims in real time and more precisely identify potentially fraudulent providers. 

That technology allowed Nevada Medicaid to make a record high number of fraud referrals this past year, with 83 credible referrals to the Medicaid Fraud Control Unit. 

What does the federal government's 'crackdown on fraud' mean for Nevada?

States may be on the hook if they pay out federal Medicaid dollars to fraudsters and can't get it back.

The Office of the Inspector General has noted that "the Federal Government is entitled to the … proportionate share of a States entire settlement or final judgment amount."

In September 2025, the federal health department's Office of Inspector General concluded Mississippi did not report and return all Medicaid overpayments for the state's fraud unit cases and recommended the state return millions of dollars to the federal government.

Nevada state officials said they will work with the federal government to ensure any uncollected debts from cases are settled appropriately in the coming months.

How successful has Ford been in prosecuting Medicaid fraud?

Since December 2020, when the Medicaid Fraud Control Unit began tracking the metric, more than 44 percent of referrals to the fraud unit were accepted for full criminal investigation. In a letter to a state lawmaker, Ford wrote that the acceptance rate is twice that of the national average in 2025. 

An analysis of a 2025 statistical chart for Medicaid Fraud Control Units across the U.S. indicates that in 2025 Nevada's caseload skewed heavily toward fraud rather than abuse, with its fraud investigations (314) dwarfing its abuse or neglect investigations (13). Convictions and criminal recoveries rank the state in the top quarter of states, but its abuse or neglect investigations place the state near the bottom, ranking 40th, including Puerto Rico. Nevada is middle of the pack in terms of its staffing. 

Of the referrals that did not result in a full criminal investigation, Ford noted that more than half were not opened because of evidentiary issues, lack of Medicaid relevance or because the referral did not allege criminal fraud. Resource constraints, specifically investigators already operating with a full or excessive caseload, were the remaining reasons.

How much debt has been collected?

Only about $12 million, or about 30 percent of the money that Ford and his office have won in court, has been collected.

"At the end of the day, everybody is trying their best to collect and get these monies. But I mean, to a certain degree, sometimes this money — it just isn't there," Schulke said, later adding that the 20-person office needs more staff and resources to adequately tackle Medicaid fraud as it's grown.

Of the roughly $12 million collected, about $6.4 million was sent back to the federal government, Medicaid kept $1.6 million to replenish its budget for services and the attorney general's office kept the other $4 million to continue its enforcement work.

As far as the uncollected dollars, Ford's office said it turned over $11.5 million in uncollected debt to the State Controller's Office, and the Medicaid Fraud Control Unit is still working to collect more than $20 million. State lawmakers have raised questions about the collection and allocation of the dollars, and the controller's office said some debts that were almost three years old were turned over to them "without explanation for why they were not turned over sooner."

How did fraud become a campaign issue and will it matter in the governor race?

It's an open question whether the ads accusing Ford of being "asleep at the switch" when it comes to prosecuting Medicaid fraud will stick.

Ryan Baxter-King, an assistant political science professor at UNR, said that as politics has been increasingly nationalized, voters are paying less attention to state and local news and more to national political issues.

When they're casting a ballot for statewide, regional or local candidates, Baxter-King said voters largely make decisions based on political parties, name recognition and the "nature of the times" such as the economy or issues that affect day-to-day living. 

That name recognition is critical, especially with polling indicating that most Americans are unaware of how state government operates.

Advertisements, such as those discussing the governor race and tied to Medicaid, he said can also be a way of directing voters to associate a candidate with a particular thing, but some research has indicated that there are diminishing returns at the national level. 

"They might be kind of carefully thinking through the political issue," he said. "But most people are really busy, and they're probably not going to go through that extended process."