Recent success stories

Here are just some of the actions CMS has taken to protect taxpayer dollars.  

• One durable medical equipment provider was billing Medicare for services to a patient who had died twenty years earlier. CMS stopped payments to the provider and is taking additional action.
• The CMS Fraud Defense Operations Center stopped more than $1 million from being paid to a medical group practice that was billing Medicare for wound care services that were supposedly being performed on patients by the owner, who is a psychiatrist.
• An ongoing scam improperly enrolled four to five million people in subsidized Marketplace coverage, costing taxpayers up to $20 billion. CMS is taking action to root out these improper enrollments.
• CMS began reviewing claims prior to payment for new hospices in 4 high-risk states to stop recent problematic activities among the hospice community.
• CMS removed 18 Medicare providers convicted of a serious crime from the Medicare program to ensure people with Medicare get care from providers who meet our standards.
• Medicaid is refocusing on providing direct health services and will no longer pay for non-medical services. Spending on non-medical services in two state programs grew to nearly $2.7 billion in 2025.
• CMS took steps to protect beneficiaries and taxpayers from waste, fraud and abuse in the Medicare Advantage and Part D programs. These actions will ensure Medicare Advantage continues to offer access to critical services in an efficient, accountable manner.
• The Innovation Center will refocus on reducing program spending while maintaining or improving quality of care to make Americans healthier. After completing a comprehensive and data-driven review of models with this focus, the CMS Innovation Center will end some models early, saving taxpayers almost $750 million.
• CMS reduced funding for the Affordable Care Act (ACA) Navigator program, which only enrolled 0.6 percent of consumers despite netting $98 million in the 2024 plan year. This action could help lower premiums in the individual health insurance market.