The Iowa Department of Health and Human Services (HHS) works to make sure taxpayer money is spent the way it’s supposed to be, including for services that help people in Iowa, like Medicaid. We look into possible fraud or abuse in programs we fund, and we accept tips from anyone.
Below, you will find definitions of fraud and abuse, how to report, and what information you need to make a report.
List items for What is fraud, waste, and abuse?
Fraud means someone lies or hides the truth on purpose.
They know what they are saying or doing is false, and they use that deception to break the law or misuse public trust. This can lead to them, or someone else, getting benefits they are not supposed to receive.
Abuse means actions that cause unnecessary costs, like giving or receiving services that aren’t needed or providing services that don’t meet quality standards. Abuse is similar to fraud, but it does not require proving that the person acted on purpose or meant to break the rules.
A list of providers that are found to be in violation of the Iowa Medicaid Program.
The list identifies all individuals, organizations, and entities that Iowa Medicaid Program Integrity Unit has taken an adverse action against for the following reasons:
Iowa Medicaid Fraud-Related Case Activity (SFY 2024–2026)
All reports are reviewed, and credible allegations are referred to the Medicaid Fraud Control Unit for investigation. Iowa uses provider screening, audits, data analytics, and managed care oversight to prevent improper payments and has recovered more than $109 million since FY21.
This table reflects internal administrative referrals processed by Iowa HHS Program Integrity. It does not reflect total statewide criminal prosecutions or convictions secured by the Iowa Department of Inspections, Appeals, and Licensing's Medicaid Fraud Control Unit (DIAL/MFCU) from all referral sources.
Year
Decline
Open
Prosecuted
Referred
2024
27
15
0
42
2025
33
7
1
40
2026
15
6
0
21
Total
75
28
1
103
Iowa’s case outcomes have remained stable over the past three years, even as overall case volume shifted.
Case volume in 2026 dropped significantly, but the ratio of declines, open cases, and referrals stayed consistent, indicating strong triage and review processes.
Iowa is monitoring whether reduced volume reflects better early screening, reporting shifts, or changes in federal investigative thresholds.
