This posting provides an overview of the national and state dimensions of Medicaid fraud, as well as efforts to detect and eliminate these crimes. The piece will look closely at Medicaid fraud investigation and enforcement in Texas. While this writer was unable to obtain an estimate of the fiscal impact of Texas Medicaid fraud, national estimates of annual improper Medicaid payments from 2015 total $140 billion or a staggering 12 percent of all Medicaid spending.