What the Public Really Thinks About Fraud in Medicare, Medicaid, and ACA

The 2026 KFF Health Tracking Poll finds that voters perceive more fraud in the federal tax system and defense contracts than in Medicare and Medicaid. Only 36 percent say there is "a lot" of fraud in Medicare, compared with 52 percent for taxes.

Nonetheless, fraud in health programs drives sharp partisan divides: Republicans elevate fraud as a key campaign issue, while Democrats prioritize health care costs. Policy implementers face a dilemma: strong anti-fraud steps can jeopardize access for beneficiaries, and most voters (71%) say ensuring care matters more than rooting out fraud. Closing the perception gap demands enforcement that reassures the public without breaking the safety net.

KFF 2026 Poll: Key Findings on Fraud Perceptions

Concerns about fraud in public programs continue to shape voter attitudes, yet the intensity of those concerns varies significantly by program and by party. The 2026 KFF Health Tracking Poll reveals that Americans generally perceive higher fraud levels outside of health programs: 52% of voters say there is "a lot" of fraud in the federal tax system, compared to 46% in military and defense contracts, 46% in foreign aid, and lower figures for health programs. Only 40% of voters perceive "a lot" of fraud in Medicaid, 36% in Medicare, and 29% in Affordable Care Act marketplaces. This hierarchy suggests that public fears may be more acute in abstract or politically salient areas like taxes, while health program fraud perceptions lag behind.

Partisan Priorities: Fraud vs. Health Costs

The poll highlights a clear partisan divide in what voters want candidates to discuss. Among Republican voters, 55% say it is extremely important for candidates to talk about fraud in government health programs. In contrast, 60% of Democratic voters and 55% of independent voters prioritize discussion of health costs as extremely important. This split frames health policy debates: for one constituency, integrity and waste reduction take center stage; for another, affordability and access are paramount. The divergence means that anti-fraud messaging, such as enhanced program integrity measures, may resonate more strongly with Republican base voters, while cost-focused proposals appeal to a broader, cross-partisan audience.

Providers, Not Patients, Are Blamed for Fraud

Across party lines, larger shares of voters attribute fraud in Medicare and Medicaid to health care providers and institutions rather than individual patients. This consensus is significant for program integrity strategies. It suggests that administrative efforts targeting systemic fraud, such as auditing billing practices and monitoring provider networks, align with public perceptions. Voters do not overwhelmingly view beneficiaries as the source of misuse, which may shield individual recipients from stigma when fraud is discussed publicly. However, it also means that broad, blunt enforcement tools, like aggressive eligibility redeterminations, can be seen as misdirected, potentially undermining trust if they are perceived to punish low-income families rather than fraudsters.

Implications for Medicaid Payment Deferrals

Fraud perceptions directly influence support for policy tools like Medicaid payment deferrals, temporary holds on federal reimbursements to states. While 43% of voters believe deferring federal Medicaid payments is very or somewhat likely to save taxpayers money, only 31% think such actions will lower health care costs for people like them. This gap indicates that many see deferrals as a fiscal measure benefiting the government bottom line, not as a mechanism to improve individual financial well-being. Moreover, 65% of voters believe the deferrals are mostly motivated by politics, with 69% of Republicans viewing them as a genuine effort to reduce fraud and protect Medicaid. The perception of political motivation erodes trust and complicates implementation, especially when 71% of voters say ensuring Medicaid beneficiaries can access needed care should be a higher priority than preventing fraud.

Perceived Vs. Actual Fraud: Medicare, Medicaid, and ACA Markets

The public's perception of fraud in government health programs often far exceeds verified improper payment rates. A July 2026 KFF Health Tracking Poll found that 40% of voters believe there is 'a lot' of fraud in Medicaid, yet the official improper payment rate was just 6.12% in fiscal year 2025. Similar gaps exist for Medicare and ACA marketplace subsidies.

Who Perceives Fraud? Partisan and Demographic Breakdowns

Political messaging tells one story, but lived experience with government health programs often tells another. The 2026 KFF poll reveals deep partisan rifts in how voters view fraud in Medicare and Medicaid: Republicans consistently rank it as a top concern, while Democrats and independents prioritize health care costs. Yet when demographics and program enrollment are factored in, the picture becomes more nuanced.

Party Affiliation: A Defining Fault Line

Across party lines, larger shares of voters believe fraud is mostly perpetrated by health care providers and institutions rather than individual patients. However, Republican voters stand out in their intensity: 55% say it is extremely important for candidates to discuss fraud in government health programs, compared to 60% of Democrats and 55% of independents who instead elevate health care costs. This partisan split shapes how enforcement actions, such as Medicaid payment deferrals, are interpreted: 69% of Republicans see these as genuine anti-fraud efforts, while only 31% of all voters believe such moves are motivated by reducing fraud.

Age, Income, and the Fraud Fear Gap

Fraud anxiety is not uniformly distributed. Pew data show that older adults are heavily targeted by scams: 66% of those 65 and older reported encountering online scams in 2025. Yet younger adults are more likely to lose money (25% for ages 18 to 29 vs. 15% for 65-plus).¹ Lower-income adults also bear a heavier burden: 26% of those with lower incomes lost money to scams, versus 15% of upper-income adults¹, and they are three times as likely to feel blamed after reporting fraud.² These experiences can magnify perceptions of systemic fraud, particularly among economically vulnerable groups. Notably, however, fraud perception in health programs does not directly mirror scam victimization. While older adults face high scam volume, their direct experience with Medicare often tempers fraud fears.

The Beneficiary Effect: Trust Through Use

Individuals who actually receive Medicare or Medicaid benefits consistently report lower levels of perceived fraud compared to those outside the system. This pattern, evident across multiple surveys, suggests that firsthand exposure to program integrity measures and routine care builds confidence. For public administrators, this insight offers public service leadership lessons: amplifying beneficiary voices and transparent program safeguards can counter overblown fraud narratives that flourish among non-participants. And with polls showing 71% of voters prioritizing care access over fraud prevention, fears that payment deferrals will swell the uninsured population 2026 make trust-building communication, targeted at the specific concerns of different partisan, age, and income groups, more effective than fear-driven messaging alone.

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Policy Implications: Payment Deferrals, Access, and Trust

In Medicaid and other federal-state partnerships, politicians and administrators face a fundamental tension: clamp down on fraud or preserve easy access to care. This tension shapes public opinion and program integrity design, with major implications for vulnerable populations.

A Widening Partisan Divide in Fraud Beliefs

The KFF Health Tracking Poll reveals that 43% of voters believe deferring federal Medicaid payments is likely to save taxpayers money, and among Republicans, 69% see such deferrals as a genuine effort to reduce fraud. Yet, 71% of all voters say ensuring access to care for beneficiaries should be a higher priority than preventing fraud. This contradiction directly influences policy support: Republicans tend to prioritize fraud detection, while Democrats and independents place greater weight on cost reduction and coverage continuity.

When Fraud Fears Undermine Coverage

Large shares of beneficiaries are unaware of eligibility renewal processes. For instance, 64% did not know their state’s renewal requirements in 2022.¹ When aggressive anti-fraud measures like payment deferrals or frequent redeterminations are implemented, eligible individuals can lose coverage simply because they fail to navigate complex paperwork. Research consistently finds beneficiary fraud is negligible², yet public perception is inflated: 40% of voters see “a lot” of fraud in Medicaid, compared to 36% for Medicare. This gap erodes trust and can lower enrollment among those eligible. Moreover, 77% of Americans hold a favorable view of Medicaid, but that trust is fragile: 60% of Republicans and 55% of Democrats worry that benefit cuts could result from fraud-focused reforms.³

Searching for Balance: Trust-Building Measures

Some states have adopted All-Payer Claims Databases (APCDs), which have been associated with a 22.5% to 33.3% increase in fraud investigations.⁴ Experts caution against blunt instruments like funding caps, which risk harm without addressing root causes.⁵ Sound public policy making requires balancing enforcement with clear communication, simplifying renewal processes, and rebuilding trust among skeptical populations. When the public perceives that fraud-fighting measures are politically motivated, as 65% of voters believe, the legitimacy of program integrity efforts is undermined. Transparency about actual fraud levels and provider-focused investigations can help align perceptions with reality and preserve the access that 71% of voters demand.

The Role of Enforcement in Shaping Public Opinion

High-profile enforcement actions have become the federal government’s most visible tool for demonstrating health program integrity, yet their effect on public perceptions of fraud remains poorly understood.

The Scale of Enforcement

Each year, the Department of Justice and HHS Office of Inspector General coordinate a nationwide health care fraud takedown. In 2026, that operation charged 455 defendants, including 90 medical professionals, across 56 federal districts and 45 states and territories.² The alleged false claims exceeded $6.5 billion,² and authorities seized $182 million in assets. The year prior, a similar sweep charged 324 defendants and involved $14.6 billion in intended losses.³ Beyond these takedowns, the False Claims Act recovered $6.8 billion in fiscal year 2025, with $5.7 billion tied to health care.⁴ DOJ’s strike forces are now embedded in 26 districts, completing 17 trials in 2025 and 9 in 2026.⁵

Does Awareness Change Beliefs?

Despite the enormous sums and headline-grabbing arrests, there is little evidence that public awareness of these efforts substantially reduces perceptions of widespread fraud. Polling on this specific connection is scarce. What data exist suggest that many people do not follow enforcement news closely, and high-profile convictions can paradoxically reinforce the belief that fraud is rampant, especially when media coverage focuses on outlier cases. Moreover, the public routinely conflates improper payments (which include documentation errors and billing mistakes) with intentional fraud, blurring the statistical picture. Consequently, even successful prosecutions may not shift the public’s baseline assumption that a large share of program spending is lost to fraud.

Coupling Enforcement with Transparency

For public administrators, the implication is clear: enforcement alone will not close the perception gap. Program integrity efforts must be paired with proactive communication. Releasing accessible, plain-language data on actual fraud recoveries, audit results, and improper payment rates can help demystify the numbers. When agencies translate the work of strike forces and False Claims Act settlements into metrics that the public and policymakers can digest, they build trust incrementally. Transparency does not need to be a victory lap; it can be a standing practice that turns abstract enforcement into a tangible indicator of program stewardship.

What This Means for Public Administrators and Program Integrity

Public administrators tasked with overseeing government health programs must apply strong leadership skills for healthcare administrators to move beyond reactive enforcement and reshape how the public perceives fraud and integrity efforts. The KFF poll exposes a wide gap between actual fraud rates and voter beliefs, and that gap directly undermines trust in Medicaid and Medicare. Translating these findings into action requires deliberate strategies that correct misperceptions, protect access, and demonstrate stewardship of public funds.

Shifting Perceptions Through Targeted Communication

Administrators can close the perception gap by deploying targeted communication campaigns that correct exaggerated fraud beliefs. Because conservative and elderly voters drive the largest misperceptions, messaging should meet these audiences where they are, through local media, senior advocacy groups, and community-based organizations. Rather than simply reciting audit statistics, agencies should highlight real-world recoveries and the systemic safeguards that prevent fraud before it occurs. Emphasizing that the vast majority of fraud is perpetrated by providers, not patients, can also reframe the narrative away from beneficiary suspicion.

Balancing Enforcement with Access: A State-Level Lesson

Minnesota offers a concrete model. The state withheld over $500 million in a single quarter for suspected improper billing, accepted a corrective action plan, and has conducted more than 4,000 investigations since 2020, recovering $50 million and making 1,150 law enforcement referrals.¹² Yet Minnesota simultaneously simplified its renewal processes to keep eligible residents covered. This dual approach, aggressive fraud detection paired with streamlined access, signals that protecting taxpayer dollars and protecting beneficiaries are not competing goals. Other states, like Ohio, have imposed temporary moratoria on home health providers while updating electronic visit verification rules, combining punitive and preventive measures without freezing new enrollments.²

Data Transparency as a Trust-Building Tool

When proposing new eligibility checks or payment reviews, administrators should lead with a framing that prioritizes beneficiary protection. Phrases like "ensuring program resources reach those who truly need them" resonate more than punitive talking points. Investing in public-facing data dashboards that show real-time improper payment rates, enforcement outcomes, and recoveries builds trust through visibility, not rhetoric. CMS has encouraged states to adopt a two-year revalidation strategy focused on high-risk providers¹, and making these oversight activities publicly viewable can counter narratives that anti-fraud efforts are politically motivated. In an environment where 65% of voters already believe payment deferrals are driven by politics, transparency is the most direct path to legitimacy.

Questions to Ask Yourself

Looking Ahead: Trends and Unanswered Questions

Forty percent of voters in 2026 say there is "a lot" of fraud in Medicare and Medicaid, a figure that has held remarkably steady in recent years.¹ The perception of widespread fraud is not new, and it is not accelerating, but it remains stubbornly high. When asked in 2025, half of the public called fraud a major problem in Medicare, and 52 percent said the same about Medicaid.² These numbers suggest a well-established belief that government health programs are rife with abuse, even as actual fraud rates remain far lower.

Stability Over Time, But Data Gaps Persist

Looking back over the past decade, available evidence points to a flat trend. KFF Health Tracking Polls, along with occasional surveys from Pew and Gallup, show that the share of Americans who believe there is significant fraud in Medicare and Medicaid has neither spiked nor dropped in a lasting way. However, most of these polls do not track perceptions for each program separately or measure them consistently year to year. Instead, they often lump all federal programs together or ask about fraud in government generally. The lack of fine-grained, longitudinal data makes it hard to say whether perceptions shift in response to high-profile enforcement actions, policy changes, or political messaging.

The Research That Would Fill the Gaps

Future work needs regular polling that isolates perceived fraud for Medicare, Medicaid, and ACA marketplaces. It should also capture beneficiary experiences and public awareness of anti-fraud efforts. An important untested question: does increased transparency around program integrity actually move public opinion? Studies that pair messaging experiments with trend data could reveal whether better communication can close the gap between what people believe and what audits show.

Why the Perception Gap Carries Real Consequences

The mismatch between perceived and actual fraud is not just a polling curiosity. It drives support for policies that may restrict access to care under the banner of fraud prevention. As long as the public sees these programs as deeply flawed, administrators will face pressure to prioritize enforcement over access, sometimes in ways that harm eligible families. Addressing this perception gap requires more than data; it demands clear, empathetic communication that rebuilds trust in the institutions meant to serve millions.