Pennsylvania AG explains why state leads nation in Medicaid fraud convictions while others battle mass schemes
Pennsylvania's Republican Attorney General Dave Sunday detailed how his state has become number one in the country in convicting Medicaid fraudsters in an exclusive interview with Fox News Digital.
"As you know, in Pennsylvania we had the most Medicaid fraud convictions in the entire country last year. And the reason for that is because of how aggressively we investigate and prosecute these cases," Sunday told Fox News Digital.
"We have an absolute moral duty to protect the most vulnerable amongst us. And one of the ways we can do that is making sure that the resources that are meant to go to them actually get to them," he continued.
Amid a strong push from the White House to investigate and prosecute fraud nationwide — demonstrated through Vice President JD Vance's White House Task Force to Eliminate Fraud — Medicaid fraud in particular has come into the spotlight.
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In May, Vance's task force announced an indictment in a $46.6 million Minnesota Medicaid fraud scheme that Health and Human Services Secretary Robert F. Kennedy Jr. called the "largest autism fraud bust in American history."
And as high-profile fraud busts involving foreign nationals in Minnesota, California and other blue states increasingly highlight the prevalence of social service scams, Sunday's efforts in a purple state stand out especially.
Key to Sunday's nation-leading conviction rate, he told Fox News Digital, is the emphasis his office places on collaboration, including with his state's Democratic governor, Josh Shapiro.
"We collaborate on a lot of issues, and this is one of those issues that our offices do collaborate on. 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," Sunday explained.
In 2025, HHS's Office of the Inspector General (OIG) ranked Pennsylvania's Medicaid Fraud Control Unit number one in total fraud charges filed against individuals, while ranking Pennsylvania number three in total fraud convictions for the fiscal year 2024. For fiscal year 2025, the OIG ranked Pennsylvania third in charges and first in total convictions, suggesting a marked improvement in conviction efficiency.
"The reason why we are so successful and the reason the states that are successful are is because they're working as a team together. This is much greater than any individual office," Sunday told Fox News Digital.
"You have to work hard as an office. You have to collaborate with your federal partners, your local partners, your state partners. You have work with the different service providers. This has to be an all hands on deck effort where you collaborate and coordinate with everyone humanly possible. And that's not just to get the successful prosecutions, but it's to get their referrals. People have to know what to look for," he continued.
His collaborative efforts, combined with vigilance, have prevented Pennsylvania from falling into the same trap as Minnesota, which had the seventh most fraud convictions in 2025, according to the HHS-OIG.
"The goal is to not let those criminal enterprises take root. That is the way that you have to do this to make sure that it doesn't turn into a Minnesota. That's how you have do it. You have to stay ahead of it. Every step of the way. You can't ever let it grow. You have to watch it when it happens. And you have to make sure that you prioritize these cases, because as an AG, your time and efforts could go to a million different places. But when you're like here in Pennsylvania, we are hyper focused on community safety," Sunday said.
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He highlighted the need for collaboration, especially considering the cross-border and transnational efforts of many convicted fraudsters. The women convicted in the Minnesota autism fraud bust notably were sending millions of dollars in fraudulently obtained Medicaid payments back to their families in Kenya, prosecutors said.
"Remember, criminal enterprises, they don't care about borders and they don't pick and choose what jurisdiction that they're only going to stick to. And so collaboration can't know borders either. So we work with other states. We work across the country with other AG's offices. We do everything we can to identify these cases and then hold these actors accountable because what'll happen is a lot of times these cases will span multiple states. And so if you have an organization or a criminal enterprise that is operating in one state, there's a good chance they're operating in another state as well. And so when we can come together and work as a team, that allows us to be able to have even greater impact."
Sunday praised Vance's task force as a valuable focal point to catalyze statewide anti-fraud efforts.
"I'm very thankful for the Vice President. I'm thankful for Vice President Vance and for his efforts in bringing everyone together and to sort of create a hub and spoke model where we all can work together and collaborate because that's the only way that these cases are gonna be solved," Sunday said.
He also highlighted cases his office had prosecuted in recent months as part of their efforts.
"We had a huge conviction this year with the Broad Street Family Pharmacy in Philadelphia. And these are individuals that were billing Medicaid up to $12 million for expensive medications that oftentimes they didn't even obtain, let alone give to someone who needed that medication to stay alive. And so those are the type of cases we have to really go after, because when they are making that much money, if we don't get involved, if we didn't investigate it, they're just gonna keep doing it," he told Fox News Digital.
In that case, the state charged nine people in a sprawling alleged scheme that prosecutors say included fraudulent claims for HIV drugs and antipsychotic medications, as well as a pill purchasing kickback plot.
The alleged scheme's ringleaders — Peter Dello Buono and Frank Bengermino — were sentenced to between 1.5 and five years in prison and ordered to pay $12.25 million in restitution. Five of the other seven plead guilty to various charges, while the remaining two have pending cases.
That $12.25 million is almost equal to the amount of federal funding that Pennsylvania's Medicaid Fraud unit got in 2025. An HHS grant that composes three quarters of the state's Medicaid fraud unit funding comes in at roughly $12.8 million.
Sunday also revealed that the Medicaid fraud unit recovers over four times the amount of money it spends on investigations.
"For every dollar spent in our Medicaid section, we recover $4.64. So think about that investment. For every dollar we spend, we recover $4.64 through our investigations and convictions. And I go back to the convictions because you can obtain restitution through sentences and through convictions. And if you can't get those convictions, then you're gonna leave a lot of that money with the bad actors that you can get back to taxpayers," he told Fox News Digital.
In addition to busting blatant fraud schemes, Sunday's office also prosecutes neglect and abuse cases that involve Medicaid claimants.
"Some of these cases, especially the abuse and neglect cases are some of the absolute most horrific cases that any prosecutor sees. I'm a career prosecutor. I've been doing this for a long time. And when you see services that are supposed to be rendered that aren't and you see individuals that are seniors, that are suffering in pain as a result of it, those are cases that those individuals need to not just be charged, but they need to be convicted," he said.
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He pointed to the case of Kelly R. Gonzalez, a personal care administrator who a jury convicted on two counts of felony neglect in February when she failed to refill a care home resident's seizure medication leading to his 2021 seizure death.
"The defendant in this case, Gonzalez, was tasked with overseeing the prescribing of medication in this home. One of her jobs was making sure that residents received the prescribed medications," Sunday said. "There was a resident in that home, the victim, who did not receive the prescribed seizure medication. And the defendant, in this case, Gonzales, found out about it and still didn't provide the medication."
According to witness testimony, two of Gonzalez's colleagues informed her that her patient needed a refill, but she still failed to get his medication refilled.
"Apparently the victim in that case went 10 days without medication, and obviously when you're taking serious medication, life-saving medication and you go 10 days without it, then there can be serious ramifications," Sunday told Fox News Digital.
"So as a result of that, the victim in this case died," he concluded.
Fox News Digital contacted the White House and Shapiro's office for additional comment.