News: CMS announces new steps to prevent healthcare fraud, comments requested
Last week in a press release, CMS announced new measures to prevent Medicare and Medicaid fraud and improve patient affordability, including:
- Until further investigation is completed, CMS has deferred $259.5 million of quarterly federal Medicaid funding in Minnesota due to “questionable claims.”
- A nationwide payment postponement on Medicare enrollment for certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) suppliers.
- A request for stakeholder input on how CMS can continue to expand and strengthen its efforts nationwide towards fraud prevention.
CMS’ review of Minnesota’s Medicaid spending for the fourth quarter in fiscal year (FY) 2025 resulted in a $259.5 million deferral, including $243.8 million in state expenditures for unsupported or potentially fraudulent Medicaid claims and $15.4 million related to claims involving individuals lacking a satisfactory immigration status.
They identified “unusually high spending and rapid growth in certain service areas,” such as personal care services, home and community-based services, and other practitioner services. Minnesota can respond with further information and documentation during the ongoing review to demonstrate that the expenditures are allowable.
CMS has announced a six-month moratorium on new Medicare enrollment for certain DMEPOS suppliers to prevent fraudulent Medicare billing. In the press release, CMS stated this will give them time to explore more options to mitigate fraud, waste, and abuse perpetrated by certain DMEPOS companies.
The agency is also looking for additional ways it can tackle fraud prevention, and so is seeking commentary from stakeholders (including states, providers, suppliers, payers, technology companies, patient advocates, beneficiaries, and more).
Stakeholder comments will help inform the development of a possible future rule under CMS’ Comprehensive Regulations to Uncover Suspicious Healthcare initiative addressing fraud, waste, abuse, and program inefficiencies in Medicare, Medicaid, the Children’s Health Insurance Program, and the Health Insurance Marketplace.
Stakeholders are encouraged to provide input on existing authorities and share ideas for new regulatory approaches. Comments be submitted here by March 30, 2026.
Editor’s note: To read CMS’ press release, click here. To submit a comment, click here.