Congressman Gabe Evans Introduces STOP Medicaid Fraud Act to Crack Down on Medicaid Fraud

WASHINGTON, D.C. — Congressman Gabe Evans introduced the Strengthening Tools of Oversight to Prevent (STOP) Medicaid Fraud Act, legislation to protect taxpayers and America’s most vulnerable by helping stop fraudulent payments before taxpayer dollars are lost, and resources are no longer available to those who need them.

The legislation requires states to electronically verify that Medicaid-funded non-emergency medical transportation (NEMT) and applied behavior analysis (ABA) services were actually provided before taxpayers foot the bill. Beginning January 1, 2027, states would be required to use electronic verification systems for these services. States that already have qualifying systems in place would be exempt as long as they continue using them.

The legislation comes as Colorado faces mounting concerns over Medicaid spending, fraud, improper payments, and oversight.

“For years, blue states like Colorado have allowed scammers and criminals to exploit millions of dollars in taxpayer-funded Medicaid programs like non-emergency transport and autism therapy, turning a blind eye to the fraud and abuse overwhelming the system. Healthcare is vital, and we must protect these programs to ensure our  neighbors who need them the most have timely and reliable access. That’s why I’m proud to introduce the Strengthening Tools of Oversight to Prevent (STOP) Medicaid Fraud Act, to eliminate the inexcusable fraud in the system, and force irresponsible state governments to put our nation’s most vulnerable first.”— Congressman Gabe Evans

A new House Energy and Commerce Committee investigation into Medicare and Medicaid fraud identified both ABA services and NEMT as Medicaid programs experiencing high rates of fraud. The investigation found that states are not using their auditing and investigative authorities to their fullest potential and concluded that preventative “detect and prevent” strategies are more effective than attempting to recover taxpayer dollars after they have already been improperly paid.

The Committee’s investigation also raised specific concerns about Colorado. The report found that Colorado has not broadly invested in auditing Medicaid provider types on a programmatic level despite the state’s history of problems involving fraud and improper payments in NEMT. The Committee called on Colorado to improve its Medicaid auditing process and increase its focus on fraud investigations based on broader program trends.

The STOP Medicaid Fraud Act targets two areas where Colorado has already experienced serious problems:
Applied Behavior Analysis (ABA): A federal audit found that Colorado's Medicaid program made at least $78 million in improper payments for ABA services. Concerns surrounding Colorado's ABA system have also included a lack of oversight and complaints involving treatment facilities serving children with autism.

The Energy and Commerce investigation found broader warning signs surrounding ABA nationwide. Between 2021 and 2025, the number of Medicaid beneficiaries receiving ABA therapy increased 200 percent, while Medicaid spending on the service increased 421 percent. Federal reviews, including one in Colorado, found patterns of improper ABA payments involving services that were not covered, lacked proper documentation, or in some cases were billed by providers without the proper credentials.

Non-Emergency Medical Transportation (NEMT): Federal prosecutors have charged Colorado transportation business owners in cases alleging hundreds of thousands of dollars in fraudulent Medicaid billing. Allegations included billing Medicaid for rides that never occurred, trips without corresponding medical appointments, and, in one case, $165,000 in rides billed after the Medicaid beneficiary had died.

These problems come as Colorado's Medicaid program faces a broader spending crisis. The program finished the 2025-26 fiscal year approximately $157.9 million over budget and is currently projected to exceed its budget by approximately $443 million in the 2026-27 fiscal year.

BACKROUND:

The STOP Medicaid Fraud Act expands the use of electronic verification to Medicaid-funded NEMT and ABA services. Electronic verification is designed to confirm that services taxpayers are billed for were actually provided.

Under the legislation:

• Beginning January 1, 2027, states must electronically verify Medicaid-funded NEMT and ABA services.
• States already using a qualifying electronic verification system may continue using their existing system.
• If CMS determines a state is not complying, the state must submit a corrective action plan within 90 days and come into compliance within one year of receiving notice.

The legislation follows the Energy and Commerce Committee's recommendation that states strengthen Medicaid provider verification and improve efforts to identify and recover improper payments. The Committee found that health care fraud costs taxpayers billions of dollars annually and warned that every dollar lost to fraud is a dollar unavailable to provide care to patients who need it.