The House Energy and Commerce Subcommittee on Oversight and Investigations on Tuesday held a hearing, “Protecting Patients and Safeguarding Taxpayer Dollars: The Role of CMS in Combating Medicare and Medicaid Fraud.” This hearing was part of an ongoing effort by lawmakers to mitigate fraud, waste, and abuse in public health insurance programs. In February, the Centers for Medicare & Medicaid Services (CMS) announced a series of actions to mitigate fraud in Medicare and Medicaid, including the deferral of over $259 million in quarterly federal Medicaid funding to Minnesota for claims paid in the fourth quarter of fiscal year 2025. In addition to this announcement, the Trump administration has launched separate Medicaid program integrity inquiries in California, New York, and Maine.
During the hearing, members agreed that fraud in federal health care programs is a serious problem but diverged on whether current oversight efforts are politically motivated. The committee heard testimony from Kimberly Brandt, CMS deputy administrator and chief operating officer, who discussed the agency’s effort to shift away from a “pay-and-chase" model towards front-end fraud prevention using new machine learning algorithms to flag suspicious claims. She also described new, enhanced provider screening tools such as fingerprinting, background checks, and unannounced site visits. Brandt further highlighted additional agency efforts to curb fraud in federal health care programs, including the newly issued Comprehensive Regulation for Uncovering Suspicious Healthcare (CRUSH) request for information, to which public comments are due by March 30.
- Washington Highlights