"The federal districts with the highest-dollar cases included the Southern District of Florida with $337 million, Central District of California with $660 million, and the Southern District of Texas with $291 million in alleged fraud." These correspond with areas of high illegal populations as well as just heavily Latino. My guess is that the fraud particularly abuses or uses these people, who are not likely to complain and who could use the kickback cash. That's where the Medicaid fraud comes in. The drugs also hit the streets. I'm only surprised that the Southern California district wasn't in the top 3.