The Trump administration has set its sights on its next goal: eliminating health care fraud.
President Trump on Monday announced the creation of a task force dedicated to combating fraud, waste, and abuse in all federal benefits. On Tuesday, the administration expanded its Medicare and Medicaid fraud investigation to Republican-led Florida.
Mehmet Oz, director of the Centers for Medicare and Medicaid Services and a former television star, has become the face of the administration, releasing numerous videos, social media posts and regulations touting the agency’s efforts to stamp out fraud in industries such as hospice, home health care and durable medical equipment. In January, CMS threatened to withhold about $2 billion in funding for Minnesota’s 14 Medicaid services over the next year.
For the disability community, the crackdown feels less like the administration is rooting out crime and more like the administration is using fraud as an excuse to cut critical services — especially after last year’s administration’s tax bill cut Medicaid funding by $1 trillion over 10 years, forcing state health officials to consider cutting critical services like home care for millions of people.
Supporters worry that broadly targeting state Medicaid funding, as in Minnesota, would put people’s lives at risk. More than a quarter of Americans have a disability, and many require home care, wheelchairs, autism treatment, and non-emergency transportation, all of which are covered by CMS.
“Access to Medicaid (home and community-based services) is a matter of life and death for millions of Americans with disabilities, older adults, and their families and loved ones. We strongly oppose the overbroad action CMS is taking to freeze funding for Medicaid HCBS services in Minnesota and its threat to freeze funding for services nationwide,” wrote representatives from the Coalition on Disability and Aging and the Consortium for Voters. hindrance. These groups represent approximately 200 organizations that advocate for people with disabilities and aging populations.
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Advocates told STAT that the timing of recent targeted efforts by federal authorities is particularly problematic and threatens gains made over years of work.
“We have been fighting for decades to expand access to these services. It hasn’t been easy, but there has been bipartisan support for expanding these programs and services,” said Natalie Keene, director of federal health advocacy at Justice in Aging. “It’s exhausting to always try to protect what we have.”
Disability rights groups packed a hearing of the House Energy and Commerce Committee on Tuesday to protest the widespread practice of health officials pursuing wrongdoing. Wearing black shirts that read “Medicaid Cuts Kill Lives,” two people flanked Kim Brandt, CMS deputy administrator and chief operating officer, to answer questions about CMS’ tactics to combat fraud and explain how CMS used new artificial intelligence algorithms to stop more than $2.1 billion in allegedly fraudulent payments.
“Eradicating fraud is not just about recovering funds after the fact,” Brandt said. “It is important to prevent harm, maintain trust, and ensure these programs remain strong for current and future generations.”
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Committee chairman Rep. John Joyce (R-Pennsylvania) suggested fraud was “rampant” and Rep. Randy Weber (R-Texas) said “thieves are misusing taxpayer money.” But experts say there is no reliable measure of fraud in Medicaid or Medicare. Some of the alarming numbers cited by the Trump administration (the Department of Health and Human Services Office of Inspector General recently reported $285.2 million in overpayments for autism treatment in Colorado) are not necessarily fraud, but rather improper or potentially improper payments, which may be the result of missing documentation and are not necessarily the work of “thieves.”
State and federal authorities also have longstanding programs investigating the existence of health care fraud. The Department of Health and Human Services Office of Inspector General reported more than 1,100 convictions and $1.4 billion in recoveries in fiscal year 2024.
“Every dollar lost to fraud for (home and community-based services) is a dollar that doesn’t go to someone in need,” said Kendra Davenport, CEO and president of Easterseals, a nonprofit organization that provides home care and other services across the country. “So while we certainly would like to see less fraud, and we recognize that there’s probably some fraud, you know, we’re really outraged by the widespread accusations of fraud, waste and abuse, because we think they undermine the programs that millions of Americans depend on.”
Mr. Brandt spent much of the hearing talking about why the best way to prevent fraud is to move from a “pay and chase” approach to a more aggressive “stop and police” approach, reversing fraudulent payments before they get out. She touted a “really amazing set of algorithms” and said, “Just like Netflix tells you what movies to watch, it tells you these are high-risk people to watch.”
Brandt did not explain how these algorithms work or what factors they consider to flag something as high risk. ” Minnesota, California, New York, and now Florida have all received notices that they are being investigated or may be investigated for possible fraud. Brandt said other states will likely receive similar inquiries from CMS.
“This is very similar to what we’ve seen from decades of bipartisan agreement across administrations…where investments have been purposefully made to help people stay in their communities and homes, rather than being forced into institutions,” said Alison Berkoff, former secretary of the federal Community Living Administration.
