Creator: Patrick Connole
CMS Touts Fraud War Room’s $203 Million Success
CMS said its Medicaid Fraud War Room has been stomping out fraud, waste, and abuse, stopping more than $203 million in “potentially improper Medicaid payments.”
The Centers for Medicare and Medicaid Services (CMS) on July 28 said enforcement efforts from its Medicaid Fraud War Room (MFWR) stopped more than $203 million in “potentially improper Medicaid payments in just under 90 days.”
There was no mention in the press statement or related MFWR links to the skilled nursing sector.
Since its launch on April 23, CMS said the MFWR has coordinated actions against 50 unique, high-risk Medicaid providers identified through advanced data analytics and representing more than $203 million in Medicaid payments subject to federal exclusions and state enforcement efforts.
The one example of the effort paying off was the identification of a lab testing provider “that was excessively billing for once-in-a-lifetime gene testing. In 2025 alone, the provider received $4.5 million for repeat testing on 520 patients.”
CMS said a medical record review uncovered falsified records and a lack of medical necessity. Since identification by the War Room: The provider will be excluded following OIG‘s notification of intent to exclude from federally funded health care programs. The state where the provider was located stopped sending payments to the provider. And investigators continue to review records and pursue financial recoveries, CMS said.
Overall Tally
To date, MFWR activities have resulted in:
Forty-two Federal Notices of Intent to Exclude providers from federal healthcare programs were issued by OIG, representing approximately $160.7 million in Medicaid payments since Jan. 1, 2025.
Fifteen state enforcement actions were taken against providers based on MFWR referrals, representing approximately $46.2 million in Medicaid payments since Jan. 1, 2025.
Seven of these providers were subject to both federal and state action, meaning that 50 unique providers have been identified, representing approximately $203.3 million in Medicaid payments since Jan. 1, 2025.
For more information, visit: www.cms.gov/files/document/medicaid-fraud-war-room-fast-facts.pdf.
Questions or comments on this article? Contact Patrick Connole at pconnole@parkplacelive.com.
