In collaboration with the White House, HHS and CMS leadership announced their new initiatives to eliminated fraud in the Medicare and Medicaid programs. These new policies include a six-month moratorium on new Medicare enrolment for select durable medical equipment suppliers, deferment of Minnesota’s federal Medicaid funding and a new request for stakeholder input on fraud, waste and abuse. CMS will accept comments on its anti-fraud Request for Information through March 30th.  

Moratorium, Durable Medical Equipment Suppliers 

After hearing reports that medical equipment is a purchasing domain with some of the highest cases of fraudulent billing, CMS has announced a six-month moratorium on new Medicare enrolment for many Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) suppliers. During the pause, CMS will explore appropriate safeguards and publish information on which suppliers will be banned from participating in Medicare moving forward. CMS cites its 2025 policy reforming skin substitute pricing as the first step in keeping spending low while maintaining access to care. 

$259.5 Million Federal Medicaid Funding Deferred 

CMS states that it has reviewed Minnesota’s Medicaid spending and found “potentially fraudulent claims,” including claims “involving individuals lacking a satisfactory immigration status.” CMS says it will defer the state’s federal funds temporarily and give Minnesota a chance to rectify what the White House sees as “significant program integrity vulnerabilities.” Minnesota has responded with a lawsuit, accusing the Administration of weaponizing Medicaid to punish political opponents. 

CRUSH RFI: Comprehensive Regulations to Uncover Suspicious Healthcare 

In the CMS Request for Information (RFI), the agency is seeking new ideas for regulatory approaches to address fraud, waste and abuse, including in Medicaid and Medicare Advantage. The Agency is also asking which current requirements should be modernized to best support this goal, as well as any analytics or data-driven approaches CMS should use to develop indicators of fraud. States, providers, patients (and their advocates), suppliers, payers and app developers are invited to respond.