CMS says its “Medicaid Fraud War Room” has identified 50 high-risk providers tied to more than $203 million in Medicaid payments in its first 88 days.
In a July 28 news release, CMS characterized the payments as “potentially improper,” and didn’t name any providers or states involved.
The Medicaid unit, which launched in late April, has been described as an extension of the “Fraud Defense Operations Center,” the Medicare-focused division launched by CMS in March 2025. The two programs are part of a wider push by the Trump administration to target fraud, waste and abuse within federal healthcare programs.
As part of the Medicaid-focused operations, HHS’ Office of Inspector General issued 42 federal notices of intent to exclude providers from federal healthcare programs, representing roughly $160.7 million in Medicaid payments since Jan. 1, 2025. Notices of intent begin the exclusion process and allow providers an opportunity to respond.
States also took 15 enforcement actions based on referrals from the Medicaid unit, representing about $46.2 million, and seven providers faced both federal and state action. Separately, state Medicaid fraud control units reported nearly $2 billion in criminal and civil recoveries during fiscal year 2025.
On July 21, CMS deferred roughly $1 billion in Medicaid payments to California and Minnesota over disputed high-risk claims, though officials in both states have challenged the evidence supporting the funding pause. Days later, Indiana announced a six-month moratorium on the enrollment and certification of new providers across five Medicaid home- and community-based waiver programs, effective Aug. 1, citing fraud risk.
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