For decades, the state units that prosecute Medicaid fraud could use federal funds to pursue patient abuse mainly in facilities such as nursing homes. A 2020 change in federal law extended that authority to abuse and neglect of Medicaid patients in their own homes and other noninstitutional settings. The latest federal report on the units shows personal care attendants among the providers most often convicted in abuse and neglect cases.
What changed in federal law
Every state has a Medicaid Fraud Control Unit, usually inside the state attorney general’s office. The units are funded mostly by the federal government and are overseen by the HHS Office of Inspector General (HHS OIG).
According to OIG’s annual report for fiscal year 2025, since December 27, 2020 the units may receive federal matching funds to investigate and prosecute abuse or neglect of Medicaid enrollees in a noninstitutional or other setting. The change came from section 207 of Division CC of the Consolidated Appropriations Act, 2021. The federal rules for the units are in 42 CFR Part 1007.
In practical terms, this means a unit can now take on a case involving a personal care aide who abused a Medicaid patient at home, not only an aide working in a nursing home or similar facility.
What the 2025 numbers show
OIG reported that the units won 329 convictions for patient abuse or neglect in fiscal year 2025, out of 1,185 total convictions. The report says patient abuse and neglect includes sexual and physical abuse, but it does not say how many convictions involved sexual abuse.
The most common provider types in abuse and neglect convictions were:
- Nurse’s aides: 71
- Nurses: 60
- Personal care service attendants: 40
- Family members or guardians: 28
- Unlicensed mental health counselors: 19
Personal care attendants usually help people with bathing, dressing, meals and other daily tasks, often in the person’s home. The report does not say where each crime happened, so these numbers cannot show exactly how many cases arose in homes.
An example of how these cases begin
A January 2026 announcement from the South Carolina Attorney General’s Office shows how such a case can start. The office said its Vulnerable Adults and Medicaid Provider Fraud unit, working with local police, arrested a home care aide. It alleges that between May and August 2025 the aide committed sexual battery against a minor and a vulnerable adult at a private home in Greenville where the aide was employed to provide care.
These are charges only. The aide has not been convicted and is presumed innocent, which is why CBW is not naming the person. We mention the case only because it shows a fraud unit handling an abuse allegation that arose in a private home.
Why home settings are harder to police
Abuse at home often happens with no other staff around. The person receiving care may depend on the caregiver and may not be able to call for help. There is no front desk, no roommate and often no camera.
Oversight is also split. Medicare home health agencies must follow federal rules on patient rights, abuse reporting and aide supervision. Many personal care programs are run by states through Medicaid, and some caregivers are hired directly by families. Background-check rules for home care workers are set mostly by the states and vary. Our home health care sexual abuse page explains who may be responsible in these different arrangements.
What this means for survivors and families
If you believe a caregiver abused you or someone you love at home, you can report it to local police, Adult Protective Services or your state’s Medicaid Fraud Control Unit. A criminal case is separate from any civil claim, and deadlines for civil claims vary by state. A lawyer can review the specifics. You can learn more in our sexual assault and abuse section.
This article is general information about how these cases work. It is not legal advice, it does not create an attorney-client relationship, and no two claims are alike. If something here sounds like your situation, the useful next step is a conversation about the facts.
