Trump health care fraud crackdown alarms disability advocates

The Trump administration has set its sights on a new goal: eliminating health care fraud.

On Monday, President Trump announced the formation of a task force dedicated to eradicating fraud, waste, and abuse in all federal benefits. By Tuesday, the administration had extended its investigation into Medicare and Medicaid fraud to include Florida, which is led by Republicans.

Mehmet Oz, the head of the Centers for Medicare and Medicaid Services and a former television star, has become the administration’s spokesperson. He has released numerous videos, social media posts, and regulations that emphasize the agency’s resolve to combat fraud in sectors such as hospice, home health, and durable medical equipment. In January, CMS threatened to withhold approximately $2 billion in funding for 14 Medicaid services in Minnesota over the coming year.

However, the disability community perceives this crackdown as an excuse to cut essential services, rather than a genuine effort to tackle crime. This sentiment is especially strong after the administration’s tax bill last year reduced Medicaid funding by $1 trillion over a decade, prompting state health officials to consider ending vital services like home care for millions of individuals.

Advocates express concern that the broad targeting of state Medicaid funding, such as in Minnesota, poses a threat to people’s lives. Over a quarter of Americans have a disability, many of whom depend on the home care, wheelchairs, autism therapy, and nonemergency transportation that CMS has targeted. 

“Access to Medicaid [home and community-based services] is a matter of life, death, and independence for millions of Americans with disabilities, older adults, and their families and loved ones. We strongly oppose the overly broad actions CMS is taking to freeze funding for Medicaid HCBS services in Minnesota and the threats to freeze funding for services across the country,” stated representatives from the Disability and Aging Collaborative and the Consortium for Constituents with Disabilities, organizations that collectively advocate for people with disabilities and aging populations.

Advocates told STAT that the timing of these targeted efforts by federal authorities is particularly concerning, as it threatens the progress achieved through years of advocacy.

“We’ve been fighting to expand access to these services over decades and decades. It hasn’t been easy, but there has been bipartisan support for expanding these programs and services,” said Natalie Kean, federal health advocacy director at Justice in Aging. “To be constantly trying to defend what we have is exhausting.”

Disability rights groups filled a House Committee on Energy and Commerce hearing on Tuesday to challenge the broad approach health officials are taking in their search for fraud. Two individuals wearing black shirts with the message “Medicaid cuts will kill” stood beside Kim Brandt, CMS deputy administrator and chief operating officer, as she addressed questions about the agency’s strategies to combat fraud. She detailed how new artificially intelligent algorithms have been employed to prevent over $2.1 billion in suspected fraudulent payments.

“Crushing fraud is not simply about recovering funds after the fact,” Brandt stated. “It’s about preventing harm, preserving trust, ensuring that these programs remain strong for current and future generations.”

Committee chairman Rep. John Joyce (R-Pa.) remarked that fraud is “running rampant,” while Rep. Randy Weber (R-Texas) commented that “thieves are making way with the taxpayer dollars.” Yet, experts assert that there are no reliable measures of fraud in Medicaid or Medicare. Some significant figures presented by the Trump administration — such as the Department of Health and Human Services Office of Inspector General’s recent report of $285.2 million in overpayments for autism therapy in Colorado — are not always indicative of fraud, but might be improper or potentially improper payments due to missing documentation, rather than intentional deception.

Both state and federal authorities have long-standing programs aimed at identifying health care fraud. The Department of Health and Human Services Office of Inspector General reported more than 1,100 convictions and $1.4 billion in recoveries in fiscal year 2024. 

“Any dollar that’s lost fraudulently for [Home and Community Based Services] is a dollar that doesn’t make its way to someone in need,” stated Kendra Davenport, CEO and president of Easterseals, a nonprofit providing services like home care nationwide. “So we certainly want there to be less fraud, and we recognize there probably is some fraud, but we really take umbrage with broad accusations of fraud, waste, and abuse, you know, because we think they undermine programs that so many millions of Americans rely on.”

Brandt highlighted during the hearing that the most effective way to prevent fraud is to shift from the “pay and chase” approach to a more proactive “stop and cop” strategy, where fraudulent payments are halted before being disbursed. She praised a “really cool series of algorithms” that, “much like Netflix tells you what movie to watch, it tells us these are high-risk people you want to keep an eye on.” 

Brandt did not elaborate on how these algorithms function or what criteria they use to flag high-risk activities. Minnesota, California, New York, and now Florida have been notified of potential fraud investigations. Brandt indicated that other states will receive similar notices from CMS.

“It feels very much like a 180 from decades of bipartisan agreement across administrations … where there has been an intentional investment in helping people stay in their own communities and their own homes instead of being forced into institutional settings,” commented Alison Barkoff, the former head of the federal Administration for Community Living.