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As State Auditor, I've devoted the last eight years to uncovering waste, fraud, and abuse of Iowans' tax dollars, identifying, on average, more than $4.3 million in misused public funds each year - more than any of my predecessors. So, when the current administration established an 11-member Medicaid Fraud Elimination Task Force to root out fraud in the system, some wondered why I wasn't included. Maybe it's political, or maybe it's because I've criticized how the state administers Medicaid: privatizing it through executive order in 2016 and paying middlemen – Managed Care Organizations (MCOs) – to run the program. My Office issued three reports during my first term that revealed problems with privatization: insufficient and unreliable data from MCOs, contract violations, a nearly 900% increase in illegal denials of care, and added financial strain on providers because of late payments and arbitrarily denied claims. That doesn't just affect Medicaid recipients. Everyone bears the burden through increased healthcare costs and less access to providers, especially in rural areas where services are already scarce.
Speaking of providers - they weren't invited to the Task Force table either. Neither were Medicaid members, the people who rely on Medicaid, even though both could provide valuable input. The administration gave those seats to the MCOs.
On its face, the Task Force also duplicates the goals of the existing Medicaid Fraud Control Unit (MFCU), already operating under the Iowa Department of Inspections, Appeals, and Licensing. Redundancy equates to waste - the waste of your tax dollars.
Iowans would be better served by fully funding and staffing the existing MFCU because, according to a 2026 report by the Health and Human Services Office of Inspector General, MFCUs nationwide recovered more than $4 for every $1 spent. In FY2025, that added up to about $2 billion returned to taxpayers.
The MFCUs also prevent fraudsters from perpetuating their schemes. In the last 15 years, Iowa's MFCU investigations have resulted in sanctions, including termination from the program, against 638 individuals and 235 organizations, 27 and 7 respectively just since the beginning of the year. In a July commentary, two former directors of the state agency that oversaw Iowa's MFCU before state reorganization called the new Task Force a "sham," motivated more by politics than by finding fraud and saving taxpayers money.
The Task Force is supposed to deliver its final report to the Governor next month. I'm all for efficiency, but I'm not convinced a few months of discussion can cure what ails a complex, decades-old system already scrutinized by multiple state and federal agencies.
What I am convinced of: transparency and accountability aren't achieved by giving a privileged few seats at another bureaucratic round table. If the administration is serious about strengthening Medicaid and eliminating fraud and waste, it should start by empowering established investigators and reminding MCOs that the consequences of mismanagement and broken promises include not only removing their place at the table but also rescinding the invitation to privatization.
Rob Sand, a Democrat, is the Iowa State Auditor and a candidate for governor.