President Donald Trump and CMS Administrator Dr. Mehmet Oz are making fraud prevention a central part of the administration’s effort to protect Medicare and Medicaid dollars and reduce health care costs
WASHINGTON — President Donald Trump and Centers for Medicare & Medicaid Services Administrator Dr. Mehmet Oz are intensifying the administration’s crackdown on health care fraud, arguing that billions of taxpayer dollars can be protected by stopping fraudulent payments before the money leaves the federal government.
The effort is part of a broader campaign targeting fraud, waste and abuse across Medicare, Medicaid and the federal health insurance marketplace.
CMS announced in September that it had canceled approximately 315,000 unauthorized federal marketplace enrollments covering more than 760,000 people. The agency estimates the action will return roughly $2.2 billion in taxpayer-funded subsidies. Centers for Medicare & Medicaid Services
The administration says the strategy represents a shift from chasing fraudulent payments after they have already been made to identifying suspicious activity before federal dollars are distributed.
Earlier this year, Oz joined Vice President JD Vance and Health and Human Services Secretary Robert F. Kennedy Jr. to announce additional anti-fraud measures.
Those actions included a nationwide moratorium on Medicare enrollment for certain durable medical equipment suppliers and the Comprehensive Regulations to Uncover Suspicious Healthcare initiative, known as CRUSH, which seeks additional input on strengthening CMS fraud detection. HHS.gov
The administration has increasingly turned to technology and data analysis to identify questionable billing patterns.
In August, CMS announced that enforcement efforts had prevented more than $1.6 billion in potentially improper Medicare laboratory payments since the beginning of the Trump administration. The agency said $732 million of those savings resulted from revoking 157 laboratory providers accused of fraudulent activity from Medicare. Centers for Medicare & Medicaid Services
Oz said the problem goes directly to the financial health of Medicare.
“When laboratories bill Medicare for tests they never performed, it drains the Medicare Trust Fund,” Oz said when announcing the enforcement results. Centers for Medicare & Medicaid Services
The administration is also targeting costs beyond outright fraud.
CMS finalized changes to Medicare payments for 2026 intended to reduce unnecessary spending, improve payment accuracy and address services the agency believes have remained overpriced despite technological improvements that allow them to be performed more efficiently. Centers for Medicare & Medicaid Services
Hospital price transparency is another part of the strategy.
CMS finalized rules designed to strengthen hospital accountability, expand patients’ access to pricing information and reduce situations in which Medicare beneficiaries can face different costs for similar services depending on where those services are provided. Centers for Medicare & Medicaid Services
The administration argues that every dollar lost to fraud ultimately places additional pressure on taxpayers and the federal programs millions of Americans depend upon.
But whether eliminating fraud will translate directly into substantially lower premiums and out-of-pocket health care costs for individual Americans is a separate question. Health care prices are affected by numerous factors, including hospital charges, prescription-drug prices, insurance premiums, labor expenses and the amount Medicare and Medicaid reimburse providers.
Trump has separately pursued prescription-drug price reductions.
In September, the president announced an initiative allowing state Medicaid programs to obtain certain drugs using pricing tied to lower prices available in other developed countries. Trump said his Council of Economic Advisers estimated the agreements could save Medicaid more than $64 billion, though the ultimate savings will depend on implementation and drug utilization. Roll Call
The administration has also announced a one-time $90 Medicare payment for more than 20 million eligible Medicare Part B beneficiaries. The money will come from the $2 billion Medicare Improvement Fund and is expected to reach most eligible beneficiaries through direct deposit in October. The White House
For Trump and Oz, the argument is straightforward: Federal health programs should be paying for legitimate medical care, not fraudulent claims, unauthorized enrollments or services that were never provided.
The scale of America’s health care system means even a small percentage of fraudulent or improper spending can translate into billions of dollars.
The administration is betting that stopping more of that money before it goes out the door can strengthen Medicare and Medicaid while reducing pressure on taxpayers.
The next test will be whether those billions in claimed savings ultimately make their way from Washington’s balance sheets to something Americans can see and feel:
lower health care costs.
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