A congressional committee is probing reports of waste, fraud and abuse in Colorado’s Medicaid program, citing recent stories outlining over-billing in transportation spending and alleged improper payments in autism services.

The U.S. House Committee on Energy and Commerce has sent a letter to Gov. Jared Polis and the Colorado Department of Health Care Policy and Finance, seeking, among other things, audits and processes in place to comply with federal laws

The March 3 letter, signed by committee Chair Rep. Brett Guthrie, a Republican from Kentucky, and two subcommittee chairs, pointed to problems that they said surfaced in Minnesota, such as over-billing, falsified records, identity theft and phantom claims in Medicaid social service and health programs for a variety of populations.

The officials said they are concerned Colorado’s Medicaid program “may be similarly vulnerable” to fraud, waste and abuse that “harms Medicaid enrollees, legitimate providers, and taxpayers.”

The committee set a March 17 deadline for a response from Colorado.

Gov. Jared Polis, through a spokesperson, told Colorado Politics that “Colorado takes our oversight of our Medicaid programs very seriously, and prioritizes finding and rooting out fraud when it occurs, including referring to law enforcement. We are equally committed to ensuring people can access the care they need.”

The governor’s statement said they are reviewing the letter from the House committee. “As we prepare our response we hope that other states and the committee benefit from learning about Colorado’s tough anti-fraud measures.”

The letter cited recent data on Colorado Medicaid spending, which it said had surpassed $14.6 billion, of which $8.6 billion came from the federal government. That spending has doubled in the past decade, despite enrollment growing by only 7%.

The committee zeroed in on programs it said are high risk for waste, fraud, and abuse, such as non-emergency medical transportation, applied behavioral analysis (ABA) services for children with autism spectrum disorder, and genetic laboratory services.

Spending on non-emergency transport services had jumped 436% between 2019 and 2025, the letter said — because the Colorado Department of Health Care Policy and Financing (HCPF) provided “incorrect guidance” to non-emergency providers, such as identifying beneficiaries with extra-large wheelchairs as needing specialty ambulances.

The congressional committee noted HCPF has corrected that inaccurate guidance, which could save $60.5 million in fiscal year 2026-27.

The committee also cited reports of fraudulent billing totaling more than $25 million in the non-emergency transport program, the letter said.

News reports said a significant spike in rate change resulted in the non-emergency medical transport ballooning in costs to $303 million in 2024 from $70.5 million in 2022.

Such payments have since been halted.

Last month, the U.S. Attorney for Colorado filed criminal charges against two individuals for fraudulent billing in the non-emergency medical transport program.

The state’s Medicaid Fraud, Abuse and Neglect Unit has recovered more than $50 million through court orders, convicted 62 defendants, and settled more than 100 civil fraud cases, said Lawrence Pacheco, a spokesperson for the Attorney General’s Office. The unit is funded jointly by state and federal dollars.

The unit has roughly six open investigations into suspected medical transportation fraud.

The surge in abnormal billing was detected almost two years ago, triggering an investigation that led lawmakers to pass a new law allowing HCPF to suspend a provider’s Medicaid enrollment over alleged misconduct, Marc Williams, a spokesperson, said. The legislation expanded the department’s administrative authority during active fraud investigations.

As for the applied behavioral analysis program, the congressional panel cited a recent investigation by the U.S. Department of Health and Human Services Office of Inspector General, which uncovered at least $77.8 million — $42.6 million in federal funding — in improper payments.

The problems in the program included session notes that didn’t describe the services provided, unauthorized recreational, academic, and daycare activities, and failure to conduct background checks for some of the behavioral technicians. The inspector general discovered some of the technicians had committed offenses that could put children in danger.

And in September 2024, seven executives of a genetic testing laboratory company were indicted by a federal grand jury for $40 million in alleged fraud to Medicare and Colorado Medicaid, the letter noted.

Defendants allegedly paid kickbacks and bribes in a scheme to defraud public and private health insurance payers.

The committee asked the governor and HCPF to provide written responses to 10 questions, covering the period from Jan. 1, 2021, to the present.

That includes information on improper payments and recovery efforts; how Medicaid providers are screened, in compliance with federal law; steps the state is taking to sanction or disenroll fraudulent Medicaid providers; the process the state is using to send criminal referrals for suspected Medicaid fraud to state, local, and federal law enforcement agencies; and what actions are being taken to identify Medicaid fraud.

Medicaid’s budget in Colorado has ballooned in the past several years and is now the single largest expenditure in Colorado’s state budget. Overspending by Medicaid, which the state is required to pay, has resulted in shortfalls in the state budget, both in 2025-26 and is expected to occur again in 2026-27.

The Medicaid budget crisis is expected to get worse when the impacts of H.R. 1, the Trump administration’s budget bill, take effect, and the state will be expected to pick up a larger share of both administrative and service costs.

A recent analysis by the Common Sense Institute estimated that HCPF spending reached $16 billion in 2025 — a 101% increase since 2015 — even as Medicaid enrollment returned to nearly its 2015 level.

The report attributed much of the growth to policy expansions, rather than enrollment or medical inflation alone. State officials have previously pointed to Colorado’s Medicaid Sustainability Framework, which argues program growth has outpaced revenue limits under the Taxpayer’s Bill of Rights, creating structural budget pressure.

The Denver Gazette’s Nico Brambila contributed to this report.