Oz Pressures States as Medicaid Fraud Crackdown Gains Steam

The Trump administration announced it will request that states verify whether providers receiving Medicaid payments are genuinely providing the services for which they’re filing claims.

Centers for Medicare & Medicaid Services Administrator Mehmet Oz, in a health conference on Tuesday, said the agency is asking states to share how they plan to evaluate the eligibility of Medicaid providers in areas that are at a high risk for fraud.

Oz said the verification process, which will be detailed in a notice to states released later this week, will help determine whether providers on the Medicaid payroll exist and are qualified to provide the services they say they offer.

The efforts are part of the Trump administration’s push to crack down on fraud in the Medicaid program. States across the country have faced intense federal scrutiny over the oversight of their Medicaid programs, which have led to hundreds of millions of dollars in deferred funds.

Oz pointed to Los Angeles as an example of an area at high risk of Medicaid fraud. In April, the administration announced arrests of Los Angeles area hospice providers accused of stealing millions in taxpayer dollars for end-of-life care. Los Angeles leads the country in hospice provider density at 1,800, a number that Oz told the audience was “impossible” and an example of “weaponized fraud” and the government’s deliberate aversion to tackling “what is so evident to everybody on the ground.”

Oz said states will have 30 days after receiving the CMS’s request to share their plans to re-evaluate providers.

“This is an example of what we’d like them to do to prove that they’re serious about this. And if you don’t take it seriously, it indicates to us that we might have to take the audits that we’re doing to different states more aggressively,” said Oz.

“We are asking the states to own that problem,” he added.

The CMS didn’t immediately respond to a request for comment on additional details.