Statistical flags indicate unusual patterns — not proof of fraud or wrongdoing. Read our methodology

InvestigationFebruary 19, 2026·12 min read

Minnesota: America's Medicaid Fraud Capital

Minnesota has some of the most generous Medicaid programs in the country — and some of the weakest oversight. The result? A state with 1.7% of America's population accounts for 5.9% of all federal exclusions in fraud-heavy categories like home health, personal care, and transportation services. The DOJ has set up a special strike force just for Minnesota. People literally fly in from other states to commit Medicaid fraud here.

1,369
MN Providers Excluded
5.9%
Of National Fraud-Heavy Exclusions
81%
Of All Interpreter Fraud is in MN
161
Fraud Convictions Since 2023

December 2025: The $9 Billion Bombshell

In December 2025, the U.S. Attorney for Minnesota dropped a number that rewrote the narrative: Medicaid fraud in Minnesota-run services likely exceeds $9 billion across 14 programs — including housing services (Integrated Community Supports), autism therapy (EIDBI), personal care, and more. Not millions. Billions. The announcement turned a state-level scandal into a national political crisis.

On December 18, 2025, federal prosecutors unveiled new charges in what they called "industrial-scale" Medicaid fraud. Providers were billing $100,000 to $200,000 per year per client for housing services that were never delivered. One provider — Ultimate Home Health Services — billed$1.1 million between June 2024 and August 2025 for services not provided. These aren't billing errors or gray-area upcoding. This is phantom billing at industrial scale.

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DOJ Strike Force

The Department of Justice created a special strike force specifically for Minnesota Medicaid fraud — an almost unheard-of step for a single state. When the federal government sets up a dedicated task force for your state's fraud problem, it's no longer a local issue. It's a national emergency.

🏛️

House Oversight Committee

On December 31, 2025, the U.S. House Oversight Committee invited Governor Tim Walz and Republican state legislators to testify about the crisis. Walz called the $9 billion estimate "sensationalized." Minnesota's State Medicaid Director said they have evidence of "tens of millions" in fraud — not $9 billion. The gap between those numbers tells you everything about the state's posture: minimize, deflect, dispute the math.

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Feeding Our Future Update

78 indictments

The Feeding Our Future case has now reached 78 indictments and nearly 60 convictions, with the investigation sprawling well beyond the original nonprofit. The web of defendants keeps expanding — and overlapping with other fraud schemes. At least one defendant in the Feeding Our Future case was also charged in the assisted living fraud scheme — collecting state money while awaiting trial on the meal fraud charges. The same networks, the same people, exploiting program after program.

⚡ The Political Dimension

This is now a national political story. Governor Tim Walz — a former vice presidential candidate — is under direct scrutiny for his administration's oversight failures. The $9 billion estimate, whether precise or not, has made Minnesota Medicaid fraud a talking point in Washington. The House Oversight hearings, the DOJ strike force, and the sheer scale of the numbers have elevated this from a state government failure to a federal accountability crisis. The question is no longer whether Minnesota's oversight failed — it's how many billions were lost while it did.

The Scale of the Problem

When the federal government catches a healthcare provider committing fraud, they're placed on the OIG Exclusion List — permanently banned from billing Medicare and Medicaid. There are currently 83K providers on this list nationwide. (Our analysis found that 40 excluded providers still appear in Medicaid billing data.)

Minnesota has 1,369 of them — 1.7% of the national total. That alone isn't shocking for a mid-sized state. But look closer at what types of fraud these exclusions involve, and a disturbing pattern emerges.

In fraud-heavy categories — home health agencies, personal care providers, medical transportation companies, and interpreter services — Minnesota accounts for 5.9% of all national exclusions. That's nearly 4 times what you'd expect based on population. (See our full state-by-state geographic risk analysis for how Minnesota compares.)

Fraud-Heavy Exclusions Per Million Residents

Home health, personal care, transportation, interpreter services

#1AK
105 exclusions150/M
#2LA
364 exclusions79.1/M
#3WV
131 exclusions72.8/M
#4MN ⚠️
320 exclusions56.1/M
#5PA
489 exclusions37.6/M
#6IA
119 exclusions37.2/M
#7OR
151 exclusions36/M
#8MS
106 exclusions35.3/M
#9OH
389 exclusions33/M
#10IL
375 exclusions29.8/M

What's Being Exploited

Minnesota's Medicaid program offers unusually generous community-based services: personal care attendants, home health aides, medical transportation, housing stabilization, interpreter services, and day treatment. These programs were designed with good intentions — keeping disabled and elderly people in their communities instead of institutions.

But generous programs with minimal verification create a simple equation: more money + less oversight = more fraud. And that's exactly what happened.

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Personal Care & Home Health

270+ providers excluded. Billing for care never provided, ghost employees, fabricated timesheets. PCA services (code T1019) alone account for over $113 billion in national Medicaid spending.

MN: 155 personal care + 117 home health exclusions
🚐

Medical Transportation

29 transportation companies excluded in Minnesota — 4th highest in the nation. Billing for rides that never happened, phantom passengers, made-up destinations. Faribault (pop. 24,000) alone has 8 transportation fraud exclusions.

MN #4 nationally for transport fraud
🗣️

Interpreter Services

This is the most striking number: 13 of 16 interpreter/translator fraud exclusions in the entire country are in Minnesota. 81%. Billing for interpretation services that never occurred or greatly exaggerating hours.

81% of ALL national interpreter fraud
🏠

Housing Stabilization

Minnesota's Housing Stabilization Services (HSS) program has attracted "fraud tourists" — people traveling from other states to exploit the program. In February 2026, two Philadelphia men pleaded guilty to a $3.5 million HSS fraud scheme using AI-generated fake records.

DOJ: First AI-assisted Medicaid fraud case

"Fraud Tourists": When Other States Target Your Programs

On February 10, 2026, the DOJ announced that two Pennsylvania men had pleaded guilty to "repeatedly traveling from Philadelphia to Minneapolis to defraud Minnesota's Housing Stabilization Services program of approximately $3.5 million."

They marketed themselves as "The Housing Guys" at homeless shelters, recruited vulnerable Medicaid beneficiaries, and when insurance companies questioned their claims, they used artificial intelligence to fabricate records.

The DOJ called it "part of a collaboration between the U.S. Attorney's Office for the District of Minnesota and the Criminal Division's Fraud Section to combat prolific fraud on government programs in Minnesota." When the DOJ has a special collaboration just for your state's fraud problem, you know it's bad.

Minnesota is so well-known for fraud vulnerability that it has become a destination. The term "fraud tourist" — used in the DOJ's own press release — tells you everything about how the state's programs are perceived by organized criminals.

The Faribault Cluster

Faribault, Minnesota is a city of about 24,000 people, roughly 50 miles south of Minneapolis. It has 21 OIG-excluded providers — a staggering number for a small city. Eight of those are transportation company fraud cases, nearly all since 2019.

Faribault Exclusions (21 total)

Foos IgalTRANSPORTATION CO
2026-01
Bishara AbdirahmanTRANSPORTATION CO
2025-12
Yusuf LohosTRANSPORTATION CO
2025-12
Fardosa IbrahimTRANSPORTATION CO
2025-07
Ali AbdiTRANSPORTATION CO
2024-11
John AkonkohNURSE/NURSES AIDE
2024-10
Abdullahi MohamedTRANSPORTATION CO
2023-05
Muna MohamedLOCAL GOV'T
2023-05
Liban SheikhdonTRANSPORTATION CO
2023-05
Idris MohamedTRANSPORTATION CO
2022-11
Brian MossRECIPT/BENEFICIARY
2022-11
Shafi HusseinTRANSPORTATION CO
2019-06
Keimani LovePERSONAL CARE PROVID
2017-03
Earl ChoateHEALTH CARE AIDE
2011-08
Thomas FolsomPSYCHIATRY
2009-04
Michael HickHEALTH CARE AIDE
2008-05
Rebecca WaskoskyBUSINESS MANAGER
2006-07
Katherine GarciaBUSINESS MANAGER
2004-03
Melissa MadsonNURSE/NURSES AIDE
2001-10
Shelley TurnerNURSE/NURSES AIDE
1999-04
Rose KramerNURSE/NURSES AIDE
1998-01

A Fraud Epidemic That's Getting Worse

The numbers have been accelerating. In 2018, Minnesota had just 9 exclusions in fraud-heavy categories. By 2023 and 2024, that number hit 44 each year — a nearly 5x increase.

MN Fraud-Heavy Exclusions by Year

2018
9
35 total
2019
36
73 total
2020
20
41 total
2021
9
32 total
2022
30
70 total
2023
45
72 total
2024
46
86 total
2025
25
54 total
2026
11
14 total

The Bigger Picture: Minnesota's Fraud Epidemic Goes Far Beyond Medicaid

Our OIG exclusion data captures only the Medicaid/Medicare fraud side. But Minnesota's fraud problem extends across virtually every federal social services program the state administers — and the scale is staggering.

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Feeding Our Future — $250M+ Stolen

Largest Pandemic Fraud in US History

A Minnesota nonprofit that claimed to distribute meals to schoolchildren during COVID-19. Federal prosecutors say it stole over $250 million while providing few or no meals at most locations. Attorney General Merrick Garland called it the country's largest pandemic relief fraud scheme.

At its peak, Feeding Our Future listed 299 "meal sites" claiming to serve 90 million meals in under 2 years — over 120,000 meals per day. One site the FBI surveilled claimed 6,000 meals/day but averaged about 40 visitors. Only ~3% of funding was actually spent on food.

As of early 2026, 78 individuals have been indicted, with nearly 60 convictions including guilty pleas and those found guilty at trial, including scheme leader Aimee Bock. The state's education department flagged fraud signs as early as 2019, but a lawsuit alleging racial discrimination created a chilling effect on oversight — a state legislative audit later confirmed this pressure compromised the agency's ability to investigate.

Political connections: The scheme involved ties to Minneapolis Mayor Jacob Frey's office (adviser Abdi Salah pled guilty to wire fraud), council member Jamal Osman (whose wife ran a meal site receiving $400K+), and state senator Omar Fateh. Multiple politicians returned donations from implicated individuals.

🧩

Autism Therapy (EIDBI) Fraud

Federal investigators found at least a dozen Feeding Our Future defendants also owned or were associated with autism therapy centers in Minnesota. In December 2025, Asha Farhan Hassan pled guilty to stealing $14 million in EIDBI (Early Intensive Developmental and Behavioral Intervention) funding. Minnesota has since paused payments in 14 Medicaid programs including autism therapy while conducting audits.

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Housing Stabilization — Shut Down Entirely

Minnesota's Integrated Community Supports (ICS) program went from $4.6 million/year at launch in 2021 to $180 million in 2025 — "explosive growth" that Minnesota has now recognized was largely fraudulent. At least 17 providers were suspended for credible fraud allegations. One ICS enrollee, Rick Clemmer, died in 2025 from a medical emergency with no one present — despite his provider billing for 12 hours of daily one-on-one care. Minnesota has since shut down the entire housing stabilization system.

💊

Substance Abuse Treatment Fraud

Evergreen, a substance abuse provider, billed for 203 hours of service from a single employee in one day. Its CEO and CFO pled guilty to conspiracy to commit wire fraud. Separately, Kyros (Minnesota's largest addiction recovery provider) used a shell nonprofit to bill Medicaid for questionable services like "watching movies" — routing 96% of the nonprofit's revenue back to for-profit Kyros subsidiaries. DHS halted payments in 2024.

⚡ The Common Thread

These aren't isolated incidents — they're interconnected. The same individuals and networks appear across multiple fraud schemes: Feeding Our Future defendants running autism therapy centers, housing fraud operators expanding into personal care, substance abuse providers exploiting billing loopholes. Minnesota's oversight apparatus failed to connect the dots across programs, allowing the same actors to exploit multiple funding streams simultaneously.

Minneapolis: The Epicenter

More than a quarter of all Minnesota exclusions — 353 — are in Minneapolis alone. Combined with Saint Paul, the Twin Cities metro accounts for the vast majority of the state's Medicaid fraud.

#1Minneapolis
353(138 fraud-heavy)
#2Saint paul
120(60 fraud-heavy)
#3Duluth
72(5 fraud-heavy)
#4Rochester
42(5 fraud-heavy)
#5St paul
39
#6Waseca
27(4 fraud-heavy)
#7Faribault
21(10 fraud-heavy)
#8Burnsville
16(4 fraud-heavy)
#9Eden prairie
15(5 fraud-heavy)
#10Stillwater
15

Recent Exclusions

Here are the most recent providers excluded from federal healthcare programs in Minnesota for fraud-heavy service categories. Each of these individuals was convicted of healthcare fraud (1128a1) or excluded for program-related conduct.

NameCityCategoryDate
Abubakar AhmedCircle PinesHome Health2026-02-19
Edna FarahHamelHome Health2026-01-20
Foos IgalFaribaultTransportation2026-01-20
Latonia JacksonMinneapolisTransportation2026-01-20
Deborah JohnsonMinneapolisPersonal Care2026-01-20
Chantal KuouSaint PaulHome Health2026-01-20
Muhidin MaowMinneapolisTransportation2026-01-20
Lorette MckinleySaint PaulPersonal Care2026-01-20
Abdikarim MohamedMinneapolisHome Health2026-01-20
Michael NornieBrooklyn CenterCounseling2026-01-20
Ahmed NurSaint PaulHome Health2026-01-20
Bishara AbdirahmanFaribaultTransportation2025-12-18
Maryam BinaWatertownPersonal Care2025-12-18
Yusuf LohosFaribaultTransportation2025-12-18
Nadia LovingBrainerdPersonal Care2025-12-18
Nusayba MohamedSaint PaulPersonal Care2025-12-18
Gao ThaoMinneapolisPersonal Care2025-12-18
Jeffrey CartharnMinneapolisPersonal Care2025-10-20
Jordan JarviAndoverPersonal Care2025-10-20
Victor KamaraMinneapolisAssisted Living2025-10-20

Organized Rings: When Multiple People Go Down Together

Medicaid fraud in Minnesota isn't just lone actors — it's organized. Since 2018, there have been 55 dates where 3 or more Minnesota providers were excluded simultaneously — a sign they were caught in the same investigation. The largest single-day action took down 20 people at once.

These coordinated exclusions typically involve clusters of home health agencies, personal care providers, interpreters, and transportation companies — all the services needed to create a complete phantom billing operation.

Largest Coordinated Exclusion Actions (2023–2026)

2026-01-20
12 excluded10 fraud-heavy
Amy Boedigheimer (Nurse)Edna Farah (HH)Foos Igal (Trans)Latonia Jackson (Trans)Deborah Johnson (PCA)Chantal Kuou (HH)Muhidin Maow (Trans)Lorette Mckinley (PCA)Abdikarim Mohamed (HH)Michael Nornie (COUNSELING)Ahmed Nur (HH)Richard Vue (MENTAL/BEH)
2025-11-20
9 excluded
Danelle Ericksen-Bentley (Nurse)Meggan Ide (Nurse)Marko Kamel (DENTIST)Kimberly Miesner (Nurse)Emran Mohammad (Nurse)Krista Peters (Nurse)Timothy Rowh (CHIROPRACT)Linda Seehusen (Nurse)Timothy Smith (Nurse)
2025-10-20
8 excluded4 fraud-heavy
Natalie Blondell (Nurse)Jeffrey Cartharn (PCA)Jordan Jarvi (PCA)Victor Kamara (ASSISTED L)Kathryn Koelfgen (HH)Shelby Parker (COUNSELOR)Katherine Peal (Nurse)Justin Winters (Nurse)
2025-08-20
10 excluded4 fraud-heavy
Leonard Cain (PCA)Jakeline Canova Cebrian (CHECK CASH)Shannyce Fitzgerald (PCA)Kelsey Fulweiler (Nurse)Mandy Hyland (SOCIAL WOR)Steven Johnson (Nurse)Augustine Livingstone (PCA)Abdirashid Mohamud (PCA)Kelly Stone (Nurse)Patti Sweeney (Nurse)
2024-10-20
8 excluded2 fraud-heavy
John Akonkoh (Nurse)Anthony Bell (DME - ORTH)Shelly Bladow (Nurse)Hunter Burroughs (DME - GENE)Riley Cullinane (CHIROPRACT)Mario Gomez (PCA)Christina Olson (Nurse)Terrence Seymour (PCA)
2024-08-20
14 excluded9 fraud-heavy
Amina Artan (HH)Ebony Cross (PCA)Dorothy Cummings (Nurse)Ladaphone Gonzalez (STATE GOV')Danisha Green (RECIPT/BEN)Tiffaney Johnson (HH)Christian Kolleh (NURSING FI)Sederick Parsons (HH)Cynthia Patrick (HH)Omer Sanyare (PCA)Eldrick Tyus (PCA)David Weatherhead (Nurse)
2024-03-20
8 excluded5 fraud-heavy
Eric Cox (PCA)Kristin Davis (HH)Ifrah Gadid (PCA)Ubah Jumale (Interp)Christopher Patterson (CHIROPRACT)Ali Said (Trans)Craig Spradlin (Nurse)Eskender Yousuf (MENTAL/BEH)
2024-02-20
17 excluded10 fraud-heavy
Mary Egere (HH)Ahmed Fahiye (Interp)Ilyas Farah (Interp)Ubah Hagi (Interp)Hodan Hashi (Interp)Tommie Johnson (PCA)Varbar Kanneh (MENTAL/BEH)Shamika Kennedy (PCA)Elifaa Kinyaiya (MENTAL/BEH)Elijah Kollie (MENTAL/BEH)Okach Kwot (COUNSELING)Ilham Mohamed (MENTAL/BEH)
2024-01-18
12 excluded7 fraud-heavy
Kwesi Akore (HH)Jennifer Draheim (PHARMACIST)Michael Egan (DENTIST)Sahra Jama (Trans)Jerome Kangas (THERAPIST)Gregory Koch (THERAPIST)Shukri Mire (Trans)Anisa Mohammed (MENTAL/BEH)Meggan Moore (PCA)Jonathan Newcomb (COUNSELING)Kendall Perkins (PCA)Yurub Sahal (Trans)
2023-12-20
10 excluded7 fraud-heavy
Sumiya Ahmed (ADULT HOME)Glenda Cryer (PCA)Adrienne Ford (HH)Joniqua Hicks (HH)Abdifatah Hirsi (Trans)Okwuchukwu Jidoefor (RECRUITER/)Jamie Meide (PCA)Sokheng Moeurn (HH)Rosalind Montgomery (Nurse)Yer Yang (HH)
2023-05-18
18 excluded12 fraud-heavy
Unnamed (HH)Abdifatah Ali (HH)Tamera Anderson (Nurse)Joseph Bauer (RECIPT/BEN)Lamar Chase (PCA)Lauren Cox (PCA)Morayo Hassan (HH)Ryan Hauth (PCA)Jong Kim (INTERNAL M)Abdullahi Mohamed (Trans)Fardowz Mohamed (MENTAL/BEH)Muna Mohamed (LOCAL GOV')
2023-04-20
20 excluded16 fraud-heavy
Conchetta Banmore (HH)Yolanda Childs (PCA)Ellese Ford (PCA)Veronica Goodwin (PCA)Ibado Hashi (Trans)Iman Hughes (HH)Shuaib Ibrahim (CLINIC)Brett Jordan (Nurse)Karen Lewis (PCA)Amina Mohamed (COUNSELING)Blair Nelson (FAMILY PRA)Stephanie Ngufor (HCA)
2023-01-19
15 excluded10 fraud-heavy
Billan Ali (Interp)Scott Charmoli (DENTIST)Joshua Cummings (PCA)Trenea Davis (PCA)Brianna Foss (PCA)Brandon Iacobo (PHARMACIST)Anab Ibrahim (Trans)Bobby Mayweather (PCA)Jennifer Mcclinton (HH)Amina Mohamud (HH)Antoinette Petty (NO KNOWN A)Abdirashid Said (INTER CARE)

Same Address, Multiple Exclusions

When multiple excluded providers share the same address, it often indicates an organized operation — a single location running multiple fraudulent entities. We found 21 addresses in Minnesota with 2 or more excluded providers.

P O Box 1000Duluth
10 excluded
Anthony Bell (DME - ORTHOTICS, 2024) · Hunter Burroughs (DME - GENERAL, 2024) · Quintan Cockerell (MARKETING FIRM, 2025) · John Dimicks (EMPLOYEE, 1989) · Jeremy Gober (CLINIC, 2025) · David Guerrero (NO KNOWN AFFILI, 2023) · Jerome Kangas (THERAPIST, 2024) · Gregory Koch (THERAPIST, 2024) · Raphael Malikian (FAMILY PRACTICE, 2024) · Eskender Yousuf (MENTAL/BEHAVIOR, 2024)
207 5Th Avenue, NMinneapolis
5 excluded
(MENTAL/BEHAVIOR, 2017) · (MENTAL/BEHAVIOR, 2017) · (MENTAL/BEHAVIOR, 2017) · (MENTAL/BEHAVIOR, 2017) · (MENTAL/BEHAVIOR, 2017)
P O Box 1731Waseca
4 excluded
Jakeline Canova Cebrian (CHECK CASHING S, 2025) · Meggan Ide (NURSE/NURSES AI, 2025) · Christina Olson (NURSE/NURSES AI, 2024) · Antonia Vega (PHARMACY TECHNI, 2025)
2501 Grand Street, N EMinneapolis
3 excluded
(, 2003) · (, 2003) · Roberta Parker (OWNER/OPERATOR, 2003)
3567 Commonwealth RdSaint Paul
3 excluded
Omar Dirie (PERSONAL CARE P, 2025) · Hodan Hashi (INTERPRETER/TRA, 2024) · Omar Osman (INTERPRETER/TRA, 2024)
2501 Grand St, N EMinneapolis
2 excluded
(, 2003) · Charlie Parker (OWNER/OPERATOR, 2003)
2200 Homestead Ave NSaint Paul
2 excluded
Kwesi Akore (HOME HEALTH AGE, 2024) · Angela Stover-Akore (HOME HEALTH AGE, 2024)
1505 E Burnsville Pkwy, #Burnsville
2 excluded
Cherylee Anderson (NURSE/NURSES AI, 1996) · Pamela Retherford (NURSE/NURSES AI, 1996)

Notable: The Akore family at 2200 Homestead Ave N, Saint Paul — Kwesi Akore (home health, excluded Jan 2024), followed by Angela Stover-Akore (home health, excluded Jul 2024). Same address, same service type, six months apart. The Clement family at 3931 Princeton Trl, Saint Paul — both excluded for home health agency fraud. And three providers at 3567 Commonwealth Rd, Saint Paul — personal care and interpreter services, all excluded within a year.

Why This Keeps Happening

Minnesota's Medicaid fraud problem isn't a mystery. It's a predictable consequence of program design:

1️⃣

Generous Benefits, Minimal Verification

Minnesota pays for services — personal care, transportation, interpretation — that many states don't cover at all, or cover with strict caps. The state's self-directed PCA program allows beneficiaries to hire their own caregivers with minimal state verification that care actually occurred.

2️⃣

Low Barriers to Entry

Starting a home health agency or transportation company in Minnesota and getting enrolled as a Medicaid provider is relatively easy. The "fraud tourists" case proves this — out-of-state individuals can set up operations and start billing quickly.

3️⃣

Pay-and-Chase Model

Like most states, Minnesota pays claims first and investigates later. By the time fraud is detected, the money is often gone — sometimes sent overseas. The average time between fraud and exclusion is years, not months.

4️⃣

Vulnerable Populations as Targets

Fraudsters recruit Medicaid beneficiaries — often elderly, disabled, or non-English-speaking individuals — to sign forms for services they never received. The beneficiaries often don't understand what they're signing or are given small payments as incentives.

The Bottom Line

Minnesota taxpayers and Medicaid beneficiaries deserve better. The state's generous programs were created to help vulnerable people — instead, they've become a feeding ground for organized fraud schemes. The DOJ shouldn't need a special strike force for one state's Medicaid fraud.

The numbers don't lie: 1,369 exclusions, 5.9% of national fraud-heavy exclusions, 81% of all interpreter fraud in America, and a 5x increase in fraud-heavy exclusions since 2018. This isn't just bad luck — it's a systemic oversight failure.

Until Minnesota implements meaningful provider verification, pre-payment auditing, and higher barriers to enrollment, the state will continue to be a magnet for fraud. And taxpayers will keep footing the bill.

Methodology

This analysis uses the HHS Office of Inspector General (OIG) List of Excluded Individuals/Entities (LEIE), which contains 83K providers excluded from federal healthcare programs. We categorized exclusions by specialty type, state, and exclusion code.

"Fraud-heavy categories" include: Home Health Agency, Personal Care Provider, Transportation Company, Interpreter/Translator, Assisted Living Facility, and Counseling Center — service types with the highest rates of documented Medicaid fraud nationally.

Exclusion type 1128a1 indicates conviction of a criminal offense related to the delivery of an item or service under Medicare or a State health care program. Per-capita rates use 2023 Census population estimates. DOJ case details from HHS-OIG Enforcement Actions database.