Heading into the midterms, voters blame doctors and hospitals for most Medicare and Medicaid fraud, KFF poll finds

Ask American voters where the fraud in Medicare and Medicaid comes from, and most of them point at the billing side of the transaction — the doctors’ offices and hospital systems that submit the claims, rather than at the patients who receive the care. That’s one of the more pointed findings in a new KFF Health Tracking Poll released July 16, which also shows that fraud has become the single most important health care issue for Republican voters heading into the midterm elections.

The poll lands in the middle of the most aggressive federal push against health care fraud in years, one that has already frozen Medicaid funding to Minnesota, paused new Medicare enrollment for durable medical equipment suppliers and put artificial intelligence (AI) in position to stop a payment before it reaches a physician’s account.

Related content: Inside the 10 worst health care fraud cases of 2026 so far

For those running honest practices, the risk the poll captures is less about being a target than about getting swept into a dragnet built to catch billing mills, and about working under a public that increasingly assumes the fraud is theirs.

Fraud is the top health issue for Republican voters

Health care costs still sit atop the electorate’s worries, as 51% of voters say they’re extremely important for candidates to address this cycle, with the future of Medicare close behind at 48%.

But KFF found a notable partisan gap on fraud. Among Republican voters, 55% ranked fraud in government health programs as extremely important, more than any other health issue and a full 18 percentage points above their next concern, health care costs, at 37%.

Fraud registered far lower for Democratic (34%) and independents voters (42%).

That Republican intensity closely tracks how the administration has sold its enforcement drive, casting fraud-fighting as a way to bring down costs.

Whether that message survives contact with the arithmetic is a separate question. About six in ten voters expect reducing fraud to cut federal spending, but only around four in ten think it will lower their own health care costs, and KFF’s own analysis is blunt: recovered fraud amounts to a small share of Medicaid spending and is unlikely to show up as savings at the kitchen table.

Pat Naples, J.D., an attorney at ArentFox Schiff who works in health care fraud enforcement, offered a caution that cuts against the poll’s partisan framing. In his read, none of this is new, and none of it is really partisan.

“This is, in a lot of ways, a continuation of what the Biden administration was doing and the first Trump administration before that,” he said in an interview with Medical Economics, describing the current campaign as the latest turn in a years-long escalation that has survived changes in the White House. “This is something that’s not going away.”

Doctors and hospitals, not patients, take the blame

The poll did not ask voters to grade themselves against their own doctors. It asked which side of a health care claim the fraud comes from: the clinicians and hospitals that bill for care, or the patients who receive it.

Asked who is mostly responsible for Medicare fraud, 53% named doctors’ offices and hospital systems and just 13% named patients, with about three in ten unsure; Medicaid split almost identically, 49% to 18%.

Majorities in every party group put the fault on the billing side. Because the people answering the survey are, by and large, the same people the programs cover, the finding is really the public pointing upstream, at whoever submits the bills, rather than at the beneficiaries who receive the care.

Voters do not, however, see health programs as the government’s worst offenders. About half said there is “a lot” of fraud in the federal tax system, 52%, and in military and defense contracts and foreign aid, both 46%, compared with 40% for Medicaid, 36% for Medicare and 29% for the marketplaces created under the Patient Protection and Affordable Care Act, the lowest figure for any area the survey tested.

Republican voters saw far more fraud everywhere, including 47% who said a lot of it runs through the Affordable Care Act marketplaces. Administration officials have pinned this year’s drop in ACA enrollment, down 5% to 23.1 million, on their anti-fraud work rather than on the expiration of the enhanced premium tax credits that made coverage more expensive for many enrollees.

The people who have actually chased this fraud tell a more complicated story about who, on that billing side, is running it.

What the OIG found in the skin-substitute boom

The clearest window into a recent Medicare fraud wave comes from a September 2025 report by the HHS Office of Inspector General with a title that left little to interpretation: “Medicare Part B Payment Trends for Skin Substitutes Raise Major Concerns about Fraud, Waste and Abuse.”

Skin substitutes are grafts used to treat chronic wounds, paid as drugs under Medicare Part B, and their billing exploded. Traditional Medicare spent $389 million on them in the third quarter of 2022; by 2024 the annual tab had passed $10 billion, and the office projected it would reach $15 billion in 2025.

David Tawes, M.A., a regional inspector general in the HHS-OIG Office of Evaluation and Inspections, walked through what drove it in an interview with Medical Economics. More patients were billed for the grafts, each was billed for more of them, and the price per unit climbed relentlessly.

By the third quarter of 2024, the average skin substitute billed to Medicare ran $1,500 per square centimeter, and a typical patient was billed for more than 80 square centimeters a quarter, roughly $120,000 every three months and triple the figure of two years earlier.

The products, Tawes said, “seem particularly vulnerable to fraud, waste [and] abuse,” and investigators have repeatedly found it.

What that fraud looked like, at its extreme, undercuts the assumption that it belongs to the treating physician. Tawes pointed to the case of Alexandra Gehrke and Jeffrey King, a Phoenix couple sentenced in October to 15.5 and 14 years in prison for causing more than $1.2 billion in false claims over 12 to 18 months.

Neither had any medical training; she had run an art studio and worked in real estate, and he was a DJ. They built a wound-care operation, hired marketers Tawes said came out of the solar panel industry, scoured nursing homes and hospices for patients with wounds, and paid nurse practitioners a flat fee to apply grafts and bill the maximum. The couple were arrested at Phoenix’s Sky Harbor airport as they prepared to leave the country. “That shows you how much money is to be made by unscrupulous actors,” Tawes said.

Gary Jacobs watched the same category of fraud wash through accountable care organizations from the payer side. Now managing director at Healthsperien and author of “The Zen Lobbyist,” Jacobs helped build value-based primary care at VillageMD and worked on Medicare’s ACO REACH program, where organizations absorbed billing they did not control.

The schemes ran nationwide, he said in an interview with Medical Economics: “It wasn’t just Arizona and Florida. It was California, Portland, Oregon, Seattle, New York City, Michigan. It was all over.”

His argument is that the physician groups closest to the billing are the ones equipped to catch it: “ACOs can control fraud if you allow us to police more effectively, because we would know what our doctors are doing, we would know where the referrals are going.”

Federal enforcement has since caught up to that category. The Justice Department’s 2026 National Health Care Fraud Takedown, announced June 23, charged 455 defendants in schemes involving more than $6.5 billion in alleged false claims, with fraudulent wound care a central target; CMS reset skin-substitute payment to $127 per square centimeter on Jan. 1. Ninety of the defendants were doctors or other licensed clinicians, but the largest cases, like Gehrke and King’s, were billing operations, not the practices seeing patients.

One structural quirk stood out in the OIG’s data: Medicare Advantage, which covers more than half of enrollees, saw only 3,800 skin-substitute patients in 2024 against 24,000 in Part B. The likely reason is a tool physicians usually resent.

“If a lot of these are fraudulent, prior authorization in Medicare Advantage will catch them,” Tawes said. His advice to physicians was plain: be skeptical of the pitch. “If you hear something that sounds sketchy or too good to be true, it’s probably not on the up and up.”

What the crackdown means for a physician’s billing

The enforcement teeth physicians are most likely to feel belong to CMS. On Feb. 25, the agency announced a package of anti-fraud actions that deferred $259.5 million in federal Medicaid matching funds to Minnesota over questionable claims, imposed a six-month nationwide moratorium on new Medicare enrollment for certain durable medical equipment suppliers, and opened a request for comment under a data-driven initiative it calls CRUSH.

Related content: CMS launches three-pronged plan to CRUSH health care fraud

HHS Secretary Robert F. Kennedy Jr. framed the shift as trading a “pay and chase” model for a “detect and deploy” strategy that uses AI to flag fraud and stop improper payments before they go out the door.

Naples walked through what that actually permits, and where it leaves a physician who gets caught in it.

The AI piece, he noted, is newer in prominence than in law: claims data mining has been a recognized basis for a credible allegation of fraud since 2011, and enforcers are “looking for large outliers in the data set.”

Asked whether a single flagged claim can justify withholding a physician’s payment, he gave what he called “the classic Law School answer. It depends.” The recourse is real but slow. A physician can file a written rebuttal statement arguing there is no credible allegation of fraud, but whether the agency credits it is “largely within the agency’s discretion,” and only after the ordinary administrative appeal is exhausted does judicial review become an option.

Suing CMS over an erroneous flag is a dead end, he added, because sovereign immunity almost certainly shields the agency.

That leaves self-protection as the practical strategy, and Naples was emphatic: “Check your own data and be on top of it and be monitoring it so that you can be prepared.” Practices that surface a problem themselves can use voluntary self-disclosure, which the department’s newer policies reward with reduced penalties.

The exposure is not limited to physicians who bill for equipment directly. A practice that merely refers patients to a durable medical equipment supplier should measure those relationships against CMS safe harbors, Naples said, because even a physician doing everything correctly “can still be a witness to an investigation” and absorb the cost of subpoenas, document production and staff interviews.

The recurring failures he sees in small practices are the familiar ones: anti-kickback and referral arrangements, thin documentation on medical necessity, and cybersecurity gaps. His counsel for practices without a compliance officer is to spot their highest-risk areas, train staff, audit referral and coding on a basic cadence and keep outside counsel on call, all of it cheaper than reacting to an enforcement action no one saw coming.

Most voters would rather protect access than chase fraud

Where the public breaks with the enforcement drive is on the trade-off itself. Seven in ten voters, 71%, said the higher priority for Medicaid should be making sure eligible people can get care, even if some fraud slips through, rather than preventing fraud at the risk of cutting off eligible enrollees.

Democratic voters, 84%, and independents, 75%, came down firmly for access, while Republican voters split almost evenly, 52% to 47%. Voters were skeptical of the state-level actions, too. The administration has deferred Medicaid payments in Minnesota and California, denied recertification of the Medicaid Fraud Control Units in Hawaii and New York and frozen funding for New York’s Medicaid fraud-prosecution agency, moves that have landed mostly on states with Democratic governors.

About three-quarters of voters, 77%, expect such delays to cost some eligible low-income people their care, 65% see them as politically motivated, and just 31% think they will lower costs for people like them.

The access voters want to protect runs largely through Medicaid, and the program’s payment rates already shape whether primary care survives, a point Morgan McDonald, M.D., national director for population health at the Milbank Memorial Fund, made in an interview with Medical Economics about primary care investment.

Most primary care physicians, herself included, would describe the field as “threatened,” she said, squeezed by thin reimbursement and rising patient need to the point that “almost a third of US adults and 12% of kids go without a usual source of primary care.” Raising Medicaid rates, in her view, is one of the clearest levers states have to widen access.

That is the collision the poll exposes. The public increasingly sees doctors and hospitals as the face of health care fraud at the same moment the tools built to pursue it, payment suspensions, billing-privilege revocations and AI-flagged holds, reach further into legitimate billing, even as the largest recoveries trace back to schemes most practices would never recognize.

Naples, Tawes and Jacobs describe the same lag from three vantage points: the older system was too slow to stop the money, and the newer one is fast enough to freeze it before anyone looks.

The open question is whether “detect and deploy” can catch the billing mills without stranding honest clinicians in the process. KFF surveyed 1,321 adults, including 1,055 voters, from June 25 to 30, with a margin of sampling error of plus or minus 3 percentage points for the full sample and 4 points for voters.