Medicaid Program Integrity
Trump Issues EO as Administration and Congress Continue their Focus on Program Integrity
President Trump this week issued an Executive Order (EO) titled “Establishing the Task Force to Eliminate Fraud.” The EO establishes a Task Force to “coordinate and accelerate a comprehensive national strategy to stop fraud, waste, and abuse within Federal benefit programs, including programs administered jointly with State, local, tribal, and territorial partners,” with a clear focus on Medicaid programs.
The Task Force will be chaired by the Vice President, with the Chairman of the Federal Trade Commission (FTC) serving as Vice Chair, and representation from nine cabinet departments, the Small Business Administration (SBA), and the Office of Management and Budget (OMB). The Task Force will coordinate measures to improve eligibility verification, implement pre-payment controls, detect high-risk fraud trends, and disrupt and dismantle fraud networks and the mechanisms through which fraud is committed. The Task Force will also coordinate development of minimum anti-fraud requirements and within 60 days of the date of the order (i.e. before May 16th) the Task Force “shall coordinate member agency efforts to adopt, as appropriate, minimum anti-fraud requirements for transactions and processes … to prevent fraud and loopholes that allow for systemic abuse and exploitation,” address how States or local governments can demonstrate implementation of the anti-fraud requirements, and “recommend, as appropriate, any ways that Federal funds may be withheld from jurisdictions that do not have adequate anti-fraud requirements”.
Additionally, Health Affairs published an article responding to the Trump Administration’s earlier activities around the issue, including a deferral of Medicaid funds in Minnesota, and the announcement from the administration of a “major crackdown” on Medicaid fraud. This crackdown comprises a nationwide moratorium on Medicare enrollment for certain durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) suppliers and a request for information (RFI) soliciting stakeholder input on potential regulatory changes that the Administration might include in a future Notice of Proposed Rulemaking (NPRM) related to “Comprehensive Regulations To Uncover Suspicious Healthcare (CRUSH).” The Health Affairs article is written by Alison Barkoff, program director at the George Washington University Milken Institute School of Public Health; Sarah Rosenbaum of the Milken Institute, and Marc Cohen and Jane Tavares of the LeadingAge LTSS Center at UMass Baston. It provides a history of the growth in home and community-based services (HCBS) and offers context for increased HCBS spending. The authors also describe the program integrity safeguards that already exist in Medicaid.
As Administration activities around Medicaid program integrity have ramped up, the US House Committee on Energy and Commerce (E&C) Subcommittee on Oversight and Investigations held a hearing on March 16th titled Protecting Patients and Safeguarding Taxpayer Dollars: The Role of CMS in Combatting Medicare and Medicaid Fraud. This follows a February 3rd hearing, Common Schemes, Real Harm: Examining Fraud in Medicare and Medicaid, which focused largely on Minnesota. Following the hearing, E&C sent letters to California (CA), Colorado (CO), Massachusetts (MA), Maine (ME), New England (NE), New York (NY), Oregon (OR), Pennsylvania (PA), Vermont (VT), and Washington (WA) to “request information related to program integrity and fraud, waste, and abuse” in each state.
NASDDDS will continue to keep members abreast of issues related to program integrity and will identify some helpful resources in the coming weeks.
FMI: See the Executive Order at https://www.whitehouse.gov/presidential-actions/2026/03/establishing-the-task-force-to-eliminate-fraud/