Key Takeaways:
- Centers for Medicare & Medicaid Services (CMS) deferred $259.5 million in federal Medicaid funds to Minnesota over program integrity concerns.
- CMS will impose a six-month nationwide moratorium on new enrollments for certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) suppliers.
- CMS issued a Request for Information seeking stakeholder feedback under its CRUSH initiative to strengthen and expand fraud prevention tools, signaling a wide range of possible new anti-fraud measures.
On Feb. 25, 2026, Vice President J.D. Vance, HHS Secretary Robert F. Kennedy, Jr. and CMS Administrator Dr. Mehmet Oz announced a series of actions aimed at strengthening program integrity across Medicare and Medicaid. The Administration characterized the initiative as part of a broader affordability strategy focused on preventing fraud, waste and abuse before…
Insurance fraud involves making false or exaggerated claims to an insurance provider.
- Hard Fraud: Someone deliberately causes a loss (e.g., setting fire to a warehouse or staging a car accident) specifically to collect a payout.
- Soft Fraud: More common and often viewed as “victimless” by the perpetrator. It involves exaggerating a legitimate claim, such as overstating the value of stolen items in a home burglary to cover the deductible.