D.C. Medicaid Behavioral Health Providers Face More Investigations, Payment Suspensions

Criminal and administrative enforcement actions targeting D.C. Medicaid behavioral health providers are increasing.

The District of Columbia is intensifying regulatory scrutiny on Medicaid behavioral health providers, with a rise in fraud investigations and payment suspensions affecting the sector. In fiscal year 2025, the D.C. Department of Health Care Finance (DHCF) investigated 55 cases of alleged Medicaid fraud, referring 17 to law enforcement. Early in 2026, DHCF had already referred three additional cases, continuing this trend.

• The Department of Behavioral Health (DBH) has placed eight providers on suspended payment status based on credible billing concerns, in line with federal program integrity rules requiring immediate suspension of payments in the event of alleged fraud.
• Over the past three years, nine people have faced criminal charges related to Medicaid fraud in D.C.'s behavioral health sector, reflecting a greater emphasis on criminal investigations and enforcement. (legal analysis)
• Providers are also grappling with delayed insurer reimbursements. Dr. Ajita Robinson of Friends in Transition Counseling reported more than $400,000 in unpaid claims and stated, “We cannot continue taking Blue Cross Blue Shield or Cigna while they’re not honoring their contractual obligation.”
• Operational pressures are mounting, with Dr. Carrie Singer of Orchard Mental Health Group noting, "We’ve been fronting payroll, salary and benefit costs for 150 providers and 50 admin staff now since about mid-December, and that’s made things incredibly difficult." (industry report)

This climate of increased oversight, payment disruptions, and compliance complexity has made risk management essential for providers’ survival and for ensuring continued patient care in the D.C. area.