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The Trump administration has zeroed in on its next target: ending health care fraud.
President Trump announced Monday the creation of a task force devoted to ending fraud, waste, and abuse in all federal benefits. On Tuesday, the administration expanded its Medicare and Medicaid fraud probe to Republican-led Florida.
The Centers for Medicare and Medicaid Services head Mehmet Oz — a former television star — has become the administration’s face, publishing numerous videos, social media posts and regulations that tout the agency’s commitment to crushing fraud in hospice, home health, durable medical equipment, and other industries. In January, CMS threatened to withhold roughly $2 billion in funding for 14 Medicaid services in Minnesota for the next year.
To the disability community, the crackdown feels less like the administration is rooting out crime and more like it is using fraud as an excuse to cut critical services — especially after the administration’s tax bill last year that slashed Medicaid funding by $1 trillion over 10 years, forcing state health officials to consider ending critical services like home care for millions of people.
Advocates worry that broadly targeting state Medicaid funding, like in Minnesota, will risk people’s lives. More than a quarter of Americans have a disability, and many of them require the home care, wheelchairs, autism therapy, and nonemergency transportation that have been targeted by CMS.
“Access to Medicaid [home and community-based services] is a matter of life, death, and independence for millions of Americans with disabilities, older adults, and their families and loved ones. We strongly oppose the overly broad actions CMS is taking to freeze funding for Medicaid HCBS services in Minnesota and the threats to freeze funding for services across the country,” wrote representatives from the Disability and Aging Collaborative and the Consortium for Constituents with Disabilities. The groups represent nearly 200 organizations that advocate for people with disabilities and aging populations.
Disability
The timing of the recent, targeted efforts by federal authorities is especially problematic and threatens gains won over many years of activism, advocates told STAT.
“We’ve been fighting to expand access to these services over decades and decades. It hasn’t been easy, but there has been bipartisan support for expanding these programs and services,” said Natalie Kean, federal health advocacy director at Justice in Aging. “To be constantly trying to defend what we have is exhausting.”
Disability rights organizations packed a House Committee on Energy and Commerce hearing on Tuesday to protest the broad brush health officials are painting in their hunt for fraud. Two people wearing black shirts that said, “Medicaid cuts will kill,” flanked Kim Brandt, CMS deputy administrator and chief operating officer, as she answered questions about the agency’s tactics for tackling fraud and explained how it has used new artificially intelligent algorithms to stop over $2.1 billion in purportedly fraudulent payments.
“Crushing fraud is not simply about recovering funds after the fact,” said Brandt. “It’s about preventing harm, preserving trust, ensuring that these programs remain strong for current and future generations.”
Committee chairman Rep. John Joyce (R-Pa.) suggested fraud is “running rampant,” while Rep. Randy Weber (R-Texas) said that “thieves are making way with the taxpayer dollars.” But experts say there are no reliable measures of fraud in Medicaid or Medicare. Some of the eye-popping 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 therapy in Colorado — are not necessarily fraud, but improper or potentially improper payments, which can be the result of missing documentation and not necessarily the work of “thieves.”
State and federal officials also have long-standing programs to look at 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.
“Any dollar that’s lost fraudulently for [Home and Community Based Services] is a dollar that doesn’t make its way to someone in need,” said Kendra Davenport, CEO and president of Easterseals, a nonprofit that provides services like home care around the nation. “So we certainly want there to be less fraud, and we recognize there probably is some fraud, but we really take umbrage with broad accusations of fraud, waste, and abuse, you know, because we think they undermine programs that so many millions of Americans rely on.”
Brandt spent much of the hearing talking about why the best way to prevent fraud was to move away from the “pay and chase” approach to a more aggressive “stop and cop” approach, in which fraudulent payments are canceled before they go out the door. She touted a “really cool series of algorithms” that, “much like Netflix tells you what movie to watch, it tells us these are high-risk people you want to keep an eye on.”
Brandt didn’t explain how these algorithms work, or what factors are taken into account by the algorithm to flag something as high risk.” Minnesota, California, New York, and now Florida have received notice that they are or could be investigated for fraud abuse. Brandt said other states will receive similar inquiries from CMS.
“It feels very much like a 180 from decades of bipartisan agreement across administrations … where there has been an intentional investment in helping people stay in their own communities and their own homes instead of being forced into institutional settings, “ said Alison Barkoff, the former head of the federal Administration for Community Living.
