Pennsylvania Attorney General describes collaboration and early intervention as keys to leading nation in Medicaid fraud convictions

Pennsylvania's Attorney General Dave Sunday described his office's approach to Medicaid fraud enforcement in an exclusive interview with Fox News Digital, saying the state ranked first nationally in Medicaid fraud convictions for fiscal year 2025, according to HHS Office of the Inspector General (OIG) data. For fiscal year 2024, the OIG ranked Pennsylvania third in total convictions and first in total charges filed against individuals; by fiscal year 2025 it had moved to first in convictions, which Sunday characterized as an improvement in conviction efficiency.

Sunday said collaboration across agencies and levels of government is central to the state's performance, including with Democratic Governor Josh Shapiro's administration. "The State Inspector General's Office works with the Pennsylvania Office of Attorney General to make sure that we receive those complaints, and then we take them and we run with them," he said. He also cited coordination with federal partners and other states' attorneys general, noting that criminal enterprises frequently operate across multiple jurisdictions.

Sunday pointed to the Broad Street Family Pharmacy case in Philadelphia as a representative example of his office's work. Nine individuals were charged in a scheme prosecutors say involved fraudulent Medicaid billing of up to $12 million for HIV drugs and antipsychotic medications that were often not obtained or dispensed. The two alleged ringleaders were sentenced to between 1.5 and five years in prison and ordered to pay $12.25 million in restitution — a sum nearly equal to the approximately $12.8 million federal HHS grant that funds three-quarters of Pennsylvania's Medicaid fraud unit.