Bureau of Special Investigations Quarter Three & Four Report - Fiscal Year 2026

During Quarters 3 and 4 of fiscal year 2026, BSI identified $10,612,582 in fraud and had $285,339 in civil recoveries.

About the Bureau of Special Investigations

Operating as a division within the Office of the State Auditor, the Bureau of Special Investigations (BSI) is charged with investigating allegations of public assistance fraud throughout the Commonwealth. BSI fraud examiners help ensure taxpayer dollars used to fund Massachusetts’ public benefits programs are managed effectively so that programs are available to residents who truly need them.

Pursuant to M.G.L. c.11, §17, BSI’s investigative authority extends to any assistance program administered by the Department of Transitional Assistance (DTA), the Department of Children and Families (DCF), and the Division of Medical Assistance, which administers MassHealth (the state’s Medicaid program). Although the Department of Early Education and Care (EEC) is not included in BSI’s enabling statute, BSI also works with EEC through a Memorandum of Understanding. As a result of BSI’s investigations, public assistance fraud cases are referred to agencies for administrative action, fraudulent overpayments are recovered through civil agreements, individuals are disqualified from programs for specified periods of time, and cases are prosecuted in state and federal courts.

BSI fraud examiners operate from six offices across the Commonwealth. BSI consists of three separate investigative units: the Central Processing Unit; the Fraud Investigations Unit; and the Data Analytics Unit. While each unit has its own specific concentration, there is extensive cross-unit collaboration and investigations often involve overlap. BSI also participates in joint investigations and task forces with other state and federal agencies that focus on combating fraudulent activities throughout the Commonwealth. BSI cases are enforced by other agencies and may be settled through civil recoupment or criminal prosecution. Our governing statute does not authorize BSI to collect settlement payments of any kind; the individual benefit programs are responsible for collection activities related to BSI cases.

During Quarters 3 and 4 of fiscal year 2026, BSI investigated a total of 2,223 cases. There were overpayment calculations in 402 cases with identified fraud. Further details regarding these 402 cases are below. 

Summary of Investigations Completed with Fraud Identified - FY26 Q3 & Q4

Assistance type	Amount	% of total*
MassHealth/Medicaid	$6,051,185	57%
Supplemental Nutrition Assistance Program (SNAP)	$3,854,119	36.3%
Personal Care Attendant (PCA)1	$538,332	5.1%
Transitional Aid to Families with Dependent Children (TAFDC)	$130,483	1.2%
Emergency Aid to the Elderly, Disabled, and Children (EAEDC)	$38,463	0.4%
Grand Total	$10,612,582	100%
Restitution Settlements (Civil Recoveries)2	$285,339

During Quarter 3 of fiscal year 2026, BSI investigated a total of 994 cases. There were overpayment calculations in 168 cases with identified fraud. Further details regarding these 168 cases are below. 

Summary of Investigations Completed with Fraud Identified - FY26 Q3

Assistance Type	Amount	%of total*
Supplemental Nutrition Assistance Program (SNAP)	$1,409,400	47.3%
MassHealth/Medicaid	$993,965	33.3%
Personal Care Attendant (PCA)	$532,172	17.8%
Transitional Aid to Families with Dependent Children (TAFDC)	$35,094	1.2%
Emergency Aid to the Elderly, Disabled, and Children (EAEDC)	$11,065	0.4%
Grand Total	$2,981,696	100%
Restitution Settlements (Civil Recoveries)	$130,014

During Quarter 4 of fiscal year 2026, BSI investigated a total of 1,229 cases. There were overpayment calculations in 234 cases with identified fraud. Further details regarding these 234 cases are below.³ 

Summary of Investigations Completed with Fraud Identified - FY26 Q4

Assistance Type	Amount	% of total
MassHealth/Medicaid	$5,057,220	66.3%
Supplemental Nutrition Assistance Program (SNAP)	$2,444,719	32%
Transitional Aid to Families with Dependent Children (TAFDC)	$95,389	1.3%
Emergency Aid to the Elderly, Disabled, and Children (EAEDC)	$27,398	0.3%
Personal Care Attendant (PCA)	$6,160	0.1%
Grand Total	$7,630,886	100%
Restitution Settlements (Civil Recoveries)	$155,325

1. PCA cases identify MassHealth overpayments for PCA services; overpayments for member healthcare benefits are identified as Medicaid.
2. BSI is unable to report on monthly collections or circumstances that produce shortfalls in collections. Restitution settlements are ongoing and continue beyond the issuance of this report. While this report informs the public of what we have found to date, benefit programs require time to implement and manage collections.
3. Q4 metrics include the resumption of referrals through the Document Benefit Fraud Task Force (DBFTF), as well as two dental providers found to be billing “impossible days” over a significant period.

Date published:	September 30, 2026