Which states have the highest Medicare recoveries reported by HHS‑OIG or DOJ in the last five years?
Executive summary
The clearest state-level finding in the available HHS‑OIG and DOJ reporting is that California’s Medicaid Fraud Control Unit produced the largest single-state recovery noted in recent federal summaries—$513 million attributed to the California MFCU in FY 2024—making California the standout state in the last five years of published recoveries [1] [2]. Federal annual and semiannual reports from HHS‑OIG and DOJ emphasize multibillion-dollar national recoveries and enforcement activity, but they do not publish a consistent, comprehensive ranked list of “highest‑recovery” states across the last five fiscal years in the materials provided here [3] [4].
1. California: the documented heavyweight in recent recoveries
HHS‑OIG’s summaries and secondary reporting single out California’s MFCU for an outsized contribution to FY 2024 totals—$513 million in recoveries—an amount that HHS‑OIG itself identified as driving a spike in criminal recoveries that year and noted by multiple observers as a major factor in the $1.4 billion MFCU total for FY 2024 [1] [2]. That state‑level headline is reinforced by HHS‑OIG’s broader assertion that MFCUs across 53 jurisdictions recovered $1.4 billion in FY 2024, with criminal recoveries hitting a ten‑year high largely because of California’s results [4] [2].
2. National enforcement totals, and why they don’t translate into a clean state ranking
HHS‑OIG and DOJ reporting emphasize national figures—HCFAC recoveries in the billions and semiannual “expected recoveries” in the multiple‑billion range—but these documents prioritize program‑level outcomes over a regular, comparable state‑by‑state scoreboard [3] [5]. For example, HHS‑OIG’s Fall 2023 Semiannual Report highlights $3.44 billion in expected recoveries from OIG work in FY 2023, and other HCFAC summaries show multibillion-dollar recoveries across Medicare and Medicaid, yet those same releases do not consistently break down recoveries by state year‑over‑year in a way that supports an authoritative five‑year ranking [3] [6].
3. Other states mentioned and limits of the public record
Reporting cites enforcement actions and sizable cases in states such as Florida and North Carolina—Florida is noted for having the highest Medicare expenditures per beneficiary in a CMS dataset, and DOJ press activity in Florida has included major fraud prosecutions—but the documents provided do not supply comparable multi‑year recovery totals for those states to place them definitively above or below others in a five‑year ranking [5] [1] [7]. Nor does the OIG work‑plan snapshot allow inference of state totals beyond indicating completed projects in places like North Carolina without aggregated dollar figures suitable for ranking [8].
4. How to interpret “highest recoveries”: enforcement focus, spending, or reporting differences?
Large recoveries in a state can reflect a mix of factors: concentrated enforcement resources (for example, an active MFCU), the size and complexity of the state’s healthcare market, high per‑beneficiary Medicare spending (as in Florida’s case), or single large settlements that skew a fiscal year’s totals [1] [5]. HHS‑OIG and DOJ materials underline this complexity—national ROI and aggregate recovery figures are emphasized, while state variability is attributed to local MFCU activity and one‑off federal cases [9] [3].
5. Bottom line and reporting gaps
The best, evidence‑based answer from the provided reporting is that California is the state with the highest documented recent recovery—at least for FY 2024—thanks to the California MFCU’s $513 million recovery that year, and that national HHS‑OIG/DOJ reports show large, fluctuating multibillion‑dollar recoveries without offering a consistent five‑year state ranking in the public materials cited [1] [2] [3]. A definitive, fully comparable list of the “highest Medicare recoveries by state over the last five years” is not present in the cited sources; producing that would require either a consolidated HHS‑OIG/DOJ dataset broken down annually by state or access to state MFCU annual reports with standardized categories [4] [8].