House Fraud Report Lists NEMT Risk Levels in 11 States, Urges Tougher Screening

On September 29, 2026, the majority staff of the House Committee on Energy and Commerce released The Real Costs of Fraud, an 87-page report on Medicare and Medicaid fraud with 13 findings and 37 recommendations. One finding names nonemergency medical transportation (NEMT) among the Medicaid services “experiencing high rates of fraud,” along with ABA therapy, home and community-based services, adult day care, and substance use disorder treatment. It is a staff report, not a law or a rule. Nothing changes for providers until Congress, CMS, or a state acts.

Which states rate NEMT high risk

NEMT is a Medicaid-only provider type, so each state Medicaid agency picks its screening level. Table 1 of the report, on page 56, gives the NEMT level in the 11 states the committee sampled:

• High risk: Colorado, Minnesota, and New York.
• Limited risk: California, Maine, Massachusetts, Nebraska, Oregon, Pennsylvania, Vermont, and Washington.

Read New York’s rating with care. On page 57, the report says New York “is not complying with federal law” on risk levels. New York told the committee it assigns risk levels only to three Medicaid-only provider types: ABA, waiver home and community-based services, and licensed home care agencies. Ask New York Medicaid which level applies to your enrollment.

Colorado moved NEMT from moderate to high risk after what the Colorado State Auditor called a “surge in NEMT fraud.” Minnesota’s 14 high risk provider types, set in 2025, include “Nonemergency Medical Transportation Services.” California and Oregon rate every Medicaid-only provider type as limited risk, and Oregon told the committee it has “no formal process to re-evaluate provider type risk levels.”

The level decides how hard it is to enroll and revalidate. Limited risk means license and database checks. Moderate adds site visits. High adds a criminal background check and fingerprints from every owner of 5 percent or more, due within 30 days of a request (42 CFR 455.450 and 455.434). The Medicaid provider risk levels page explains each step, and CMS’s CRUSH request covers where federal screening rules may go next.

What the report recommends

On page 84, the report says CMS should:

• Consider stronger guidance “to standardize Medicaid-only provider risk levels across more provider types.”
• “Establish minimum qualifications and screening risk standards for Medicaid providers, particularly high-risk provider types.”
• Check more often, nationwide, that states follow federal screening and revalidation rules.
• Require states to list the risk levels they assign in their Medicaid state plans.

It also says states would benefit from re-evaluating risk levels regularly. Another recommendation says states should “contractually require MCOs to refer potential fraud” to the right agencies on time. MCOs are Medicaid managed care plans.

The report describes charges announced in February 2026 by federal prosecutors and the Colorado Attorney General’s Office against two people accused of billing Health First Colorado over $1 million and $3.3 million for NEMT rides, including trips that never happened. It also notes that Minnesota hired an outside firm to review NEMT services from 2020 to 2022 and again starting in 2025, but not in fiscal years 2023 and 2024.

The report came out the same day committee Republicans announced a package of 14 fraud bills. One of them is the STOP Medicaid Fraud Act, which would require electronic checks of NEMT trips.

What NEMT providers should do now

The report faults states that keep NEMT at limited risk despite recent fraud. If your state raises the level, your next enrollment or revalidation gets the tougher checks.

1. Keep an office that can pass an unannounced inspection. Every enrolled provider must allow one, at any risk level (42 CFR 455.432). See the Medicaid site visit guide.
2. Keep ownership disclosures current. At high risk, each 5 percent owner has 30 days to send fingerprints once asked. See how to report changes to Medicaid.
3. Match every billed ride to a trip record. Keep the times, driver, vehicle, and signature with each claim, as laid out in NEMT trip documentation.
4. Be ready for health plan reviews. If states require health plans to refer suspected fraud promptly, as the report recommends, plans have more reason to check the trip records behind your claims.