Protecting Patients and Safeguarding Taxpayer Dollars: The Role of CMS in Combatting Medicare and Medicaid Fraud
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House Energy and Commerce Subcommittee on Oversight and Investigations U.S. House of Representatives
Follow its sittingsSpeaker 2
Medicaid is a lifeline for more than 70,000,000 people in this country. Patients pay the price when billions of dollars are withheld for entire categories of services rather than specific claims. CMS and congressional Republicans want us to believe that the cuts only hurt fraudsters, but in reality, they are intentionally tearing down the Medicaid program. These cuts to Medicaid funding are just the latest Republican efforts to reduce health care services. I don't want to see that happen in New York, Minnesota, and elsewhere in the country.
Democrats want to improve access and affordability of health care for everyone, and strengthen the federal health care system so it is efficient and sustainable. The abuse of taxpayer dollars is coming from the president of the United States, who is using government resources as his personal revenge fund to punish his political enemies. Congress should not sit by while CMS abuses congressionally appropriated funding to take vital services away from people. We don't need to choose between consistent funding for Medicaid and combating fraud. We can and must do both if we repair the damage being done by this administration and the congressional majority.
To start, we need to restore the nearly $1,000,000,000,000 Republicans cut from Medicaid in their reconciliation bill last summer. Today, we want answers from the CMS deputy administrator about the attack on health care in Minnesota, any similar plans for other states, and the impact of these attacks on the health of Medicaid beneficiaries. Deputy administrator Brent, I hope that this is an opportunity for all of us to finally get some real transparency and specifics from an expert at CMS, rather than the rudderless partisan attacks that we have seen from doctor Oz and vice president Vance at friendly news programs or at press conferences. With that, Mr. Chairman, I yield back.
Speaker 1
Thank you. The chair now recognizes the chairman of the full committee, Mr. Guthrie, for five minutes for an opening statement.
Speaker 3
Thank you, chairman. Thank you for the recognition. Thank you for being here as our witness, and good afternoon to everybody. Gosh. The Center for Medicaid and Medicare Services, they safeguard our taxpayers.
That's what you're here for. And you would think if anything could be bipartisan in this committee, it would be when people do fraud, the takeaway resources for people that really need them. I mean, people really need medication. It is important that they have. And when fraud just robs them of that.
And there are people that set up these groups that aren't just overcharging or misbilling, which is brought up there. They're improper payments. We're talking about people that set up fraudulent businesses to take money away from the people that need them the most. And not only money away from people who need them the most, take them out of the pockets of hard paying taxpayers. It is frustrating this can't be bipartisan.
And Florida's now, you just noticed Florida's under investigation. I just saw Governor DeSantis. He's not a Democrat. I can promise you that. The other, I know that I sent a letter to Nebraska.
So we're gonna follow where the fraud is. And if the fraud isn't Democrat governors, we're gonna hold them accountable for it. If it's Republican governors, we're gonna hold them accountable for it. Because the people that need this program the most are the ones who are most vulnerable. You think about who's vulnerable to fraud is a, you know, we'd we have behavioral analysis for children with autism.
They're we have those kind of programs. Non-emergency medical transportation has been in fraud. Those programs, substance use disorder treatment, people who really need those programs are being robbed because people are robbing the hard-paying tax dollars. And so, you know, it, you know, for example, just last month, a Russian citizen was charged in an alleged $3,400,000 fraud scheme involving Medicare claims for durable medical equipment. Today's hearing provides an opportunity to examine how much CMS has strengthened its efforts to detect fraud sooner, fraudulent payments, and improved coordination with states and law enforcement agencies.
It is also an opportunity to identify reforms that can further strengthen program integrity while protecting access to care for millions of Americans who rely on Medicaid and Medicare. And I look forward to hearing from you today how we're gonna deal with it. And, gosh, if you think anything could be bipartisan is when people defraud the taxpayers that work hard for the money who generously, through the programs, give it to people who are the most vulnerable, and they're being taken advantage of. They'll be taken advantage of when people don't take this seriously as well. And I will yield back.
Speaker 1
The gentleman yields. The chair now recognizes a ranking member of the full committee, Mister Palone, for five minutes for an opening statement.
Speaker 4
Thank you, Mr. Chairman. The Trump administration and congressional Republicans are continuing their crusade of ripping health care away from the American people while they spend billions of dollars on an unnecessary war in Iran, that is jacking up gasoline prices for an American public that cannot afford it. From the very beginning of this Trump administration, there's been a lot of big talk about fighting fraud. But in reality, President Trump has pardoned fraudsters and fired the very people in our federal agencies who fight fraud. Right out of the gate, President Trump fired HHS Inspector General Christie Grimm, who had overseen massive successful investigations and prosecution of fraudsters.
And federal prosecutors in Minnesota who have been working with the state to fight fraud, resign in protest of the Trump administration's lawless rampage in Minneapolis, which left two innocent Americans dead. Let me put this simply. Democrats want to fight fraud because we want to ensure every dollar is going to the people that need essential services. We believe that states and the federal government must be partners in fighting fraud. It's the only way to do it.
It's time for Republicans to drop the pretense that this is all about fraud. It is not. Instead, it is about covering up for their terrible health care policies that are stripping health care away from millions and driving up costs that make health coverage out of reach for millions more. Their $1,000,000,000,000 in health care cuts will also shutter hospitals and nursing homes, and make nursing homes less safe by dramatically reducing staffing and safety standards. Now the Republican assault on health care will rip health care away from 15,000,000 Americans and has already jacked up monthly health care premiums for 20,000,000 Americans, in some instances, either double or triple the prices that they were paying.
Instead of spending billions of dollars on the Iran war, they should use the money to bring back the ACA enhanced premium tax credits, which they let expire. Over the past two months, the administration, the Trump administration, has acted to withhold billions of dollars of federal Medicaid funding in Minnesota for services like the home health care services for the elderly and disabled people, rely on supports for autistic children, services that help people suffering from a substance use disorder recovery. And they're now preparing to go after more states for no other reason than they are run by Democrats. The Trump administration has sent letters, teeing up similar actions in California, Maine, and the ranking member of the subcommittee mentioned now Florida. Unfortunately, the Trump administration is not acting alone.
Committee Republicans are now supporting these intimidation tactics by launching a scattered investigation in 11 of 11 states. Instead, we should be investigating war profiteering by the president's friends, the oil companies, who are making more money by jacking up the oil prices. It does not matter that Minnesota has taken extensive efforts to crack down on the bad actors who perpetrate fraud. Instead of being a partner in anti-fraud efforts, the Trump administration Centers for Medicare and Medicaid Services has refused to collaborate with Minnesota and is continually moving the goalposts. Threatening to cut off all the funding the state receives for 14 critical health services.
Meanwhile, doctor Oz is painting all Somali Americans as fraudsters in Minnesota, and points to Armenian Americans in California with the same brush. And the hands doctor Az is handing is basically taking data from CMS and sending it over to ICE, so they can basically go over and continue their racist policies against Latino Americans. I mean, the list goes on, and I don't even know where to begin. But the bottom line is the only fraud here is by the Trump administration and congressional Republicans who refuse to take care of people, refuse to lower health care costs, or improve people's lives, while they continue an irresponsible war and immigration policies that are simply wrong. That's the fraud.
The fraud is on them. I yield back.
Speaker 1
The gentleman yields. That concludes members' opening statements. The chair would like to remind members that pursuant to the committee rules, all members' written opening statements will be made part of the record. We wanna thank our witness for being here today and taking time to testify before the subcommittee. You will have the opportunity to give an opening statement, followed by a round of questions from members.
Our witness today is Kimberly Brandt, deputy administrator and chief operating officer of the administrator US Centers for Medicare and Medicaid Services. We appreciate you being here today, and I look forward to hearing from you. You are aware that the committee is holding an oversight hearing, and when doing so, has the practice of taking the testimony under oath. Do you have any objection to testifying under oath? No.
Seeing no objection, we'll proceed. The chair advises that you are entitled to be advised by counsel pursuant to the house rules. Do you desire to be advised by counsel during your testimony today?
Speaker 1
We will then ask you to please rise, raise your right hand. Do you promise to tell the truth, the whole truth, and nothing but the truth, so help you God?
Speaker 1
Seeing that the witnesses had answered in the affirmative, you are now sworn in and under oath, subjected to the penalty set forth by title 18, section 1001 of the United States code. And with that, we will now recognize Deputy Administrator Brant for five minutes to give your opening statement.
Speaker 5
Thank you, Mr. Chairman. Chairman Joyce, chairman Guthrie, ranking member Clark, and ranking member Palone, as well as members of the subcommittee. I wanna thank you for having the opportunity to discuss CMS' work to combat fraud, waste, and abuse in our programs. The Centers for Medicare and Medicaid Services is entrusted with overseeing programs that provide health coverage to more than 170,000,000 Americans and accounts for nearly $1,800,000,000,000 in annual federal spending. In fact, if CMS was a country, it would have the 16th largest GDP in the world.
With that responsibility comes a clear moral mandate: protect taxpayer dollars and protect the beneficiaries who rely on those programs. Fraud is not a victimless crime, and we have an ethical obligation to address it. It siphons resources from critical health services. It undermines trust in our programs. And, most importantly, it puts patients at real risk.
Just this past week, doctor Oz and I were in Los Angeles continuing our efforts to look at hospice fraud there. As part of that visit, we visited residential homes allegedly providing care for indigent seniors, including some who purportedly were providing hospice services. Sadly, these homes were not providing any of those services. And, in fact, law enforcement had to raid one of those homes because the residents were malnourished and improperly cared for. The conditions were appalling.
Unclean living conditions, moldy food, and, most importantly, no caregivers present. Yet the owners of these homes were receiving $6,000 a month per resident. 36,000 total for six residents for services that were clearly never rendered, and yet the taxpayers were footing the bill. This is unacceptable, and why CMS is so focused on stopping these egregious behaviors to ensure the health and safety of our beneficiaries. In addition to real, immediate harm experienced by patients, fraud can leave lasting damage.
Fraudulent claims inserted into the medical record can make it so that people have their future medical decisions influenced. It can have them denied insurance coverage, and it can impact the type of care they receive years later, sometimes in ways that are difficult to undo. In addition to putting patients at risk, fraud is deeply harmful to the taxpayers. Every fraudulent claim diverts limited Medicare and Medicaid dollars away from people who genuinely need care. It drives up program costs and premiums, and it undermines public trust in the healthcare system.
And that is why CMS is taking an aggressive, data-driven approach to crushing fraud before it starts and stopping it quickly when it occurs. Prevention is our first line of defense. However, based on my 20 years of experience working on fraud, waste, and abuse issues in government, the biggest impact we can make is building strong safeguards into both provider enrollment and beneficiary eligibility systems. This is a central part of CMS' efforts to move away from the pay and chase approach of the past to a more aggressive stop and catch approach. This starts immediately when a provider goes to enroll in Medicare.
Using new algorithms, we can compare new enrollees with the characteristics of all the bad actors that we have previously terminated from the program. We then put these new high-risk providers on an enhanced watch list, monitoring their data, and doing unannounced site visits. Recent efforts in California for a 177 newly enrolled hospices resulted in sixty percent of those being revoked within six months, and thirty-five percent of the remaining ones being subject to corrective action. These efforts help ensure that only qualified, legitimate providers can bill the program. And at the same time, on the beneficiary side, we partner with states to strengthen eligibility checks for enrollees and data matching to make sure that we are protecting taxpayer dollars and preserving the benefits for those who truly qualify.
The fraudsters and their tactics are becoming increasingly sophisticated, and CMS must constantly adapt to keep pace. We are investing in advanced analytics and predictive modeling to identify suspicious billing patterns in real time. These findings are used to target our oversight resources on areas where risk is highest, and will have the greatest impact. It is these findings that helped us identify skin substitutes and other emerging schemes. Imperative to our efforts are collaborations with law enforcement and other federal agencies.
Through close coordination with our law enforcement partners, we're quickly able to identify credible allegations of fraud, support investigations with data analysis, and take swift administrative action when necessary. In just the last year, our fraud war room, or the Fraud Defense Operations Center, has resulted in stopping over $2,100,000,000 in Medicare payments across over 350 providers and suppliers. I want to thank Congress for their work to safeguard CMS programs and the people they serve. Under the Working Families Tax Cut Act, included significant Medicaid eligibility and financing reforms, including changes which aim to ensure lawful enrollment and reduce financing loopholes. It also includes provisions to help CMS address concerns about concurrent enrollments and improper payments tied to deceased beneficiaries and providers.
CMS looks forward to continuing our work with Congress and stakeholders to preserve access to care for society's most vulnerable populations. When fraud diverts resources, it threatens the sustainability of those programs. When fraud compromises care, it threatens patient safety. We have a moral obligation to protect both. CMS remains committed to strengthening oversight and using every available tool to safeguard these programs.
Crushing fraud is not simply about recovering funds after the fact. It's about preventing harm, preserving trust, and ensuring that these programs remain strong for current and future generations. Thank you, and I look forward to your questions.
Speaker 1
I thank you for your testimony, and we will now move to the questioning. I will begin and recognize myself for 5 minutes. Deputy administrator Brant, in January, we wrote a letter to HHS inspector general Mark Bell expressing our concern about disturbing patterns in provider enrollment and suspected fraud in home health and hospice companies in LA County, California. In addition, a recent CBS News investigation of hospice fraud in Los Angeles County also found alarming patterns. I ask unanimous consent to enter CBS News article entitled, we visited ground zero for hospice fraud, Los Angeles, California, dated 03/10/2026, for the record.
Without objection, so ordered, CBS found that 89 hospice organizations were registered to one single address in Van Nuys. In addition, 700 of the roughly 1,800 hospice agencies in LA County trigger multiple red flags for fraud, as defined by the state of California. They also found that 42% of hospice companies having multiple red flag indicators are still in operation. None of the hospices flagged by CBS News are in California's enforcement actions database. Deputy Administrator Brant, what's CMS doing right now to address the very real concerns surrounding hospice fraud in Los Angeles?
Speaker 5
We share your concerns, Chairman Joyce, and I appreciate you raising this. As I mentioned, Doctor Oz and I were just in Los Angeles, the second visit this year, and we've taken a number of approaches. First, as I indicated in my oral testimony, we are becoming much more aggressive in our follow-up efforts with newly enrolled hospices. We're doing site visits. We're doing data analysis, and we're striving to make sure to take them out if they are not performing as a legitimate hospice when they're enrolled.
We're also looking at the buildings that you mentioned and the companies that you mentioned that are in these facilities where you can have up to 100 or maybe 300 of these hospices all enrolled at a single location. As a result, we are upping our enforcement efforts to suspend or potentially revoke the numbers for the people in those billings, and to be able to validate their legitimate services are being provided because we don't wanna stop that. But we wanna make sure that they are stopped when they aren't legitimate. Lastly, we have sent thousands of letters to people who have been enrolled in hospice to ask them to verify that they have actually been enrolled. The CBS News piece that you mentioned had the example of a woman who was enrolled in hospice and didn't realize it until her physical therapy claims were denied.
As a result, now she would get a letter, and she would know that and be able to come back to us and say, hey. I'm not in hospice. I'm a healthy pickleball player. So that's what we're trying to do, and our hope is to take those 700-plus fraudulent hospices you're talking about down to zero before the end of the year.
Speaker 1
I think you would agree with me that all fraud is egregious. But as a doctor, hospice fraud in particular is egregious, interrupts medical care, and actually can cause a patient harm. As you have been out fighting fraud with Doctor Oz, can you talk about what you have learned about the harm specifically to Medicare beneficiaries that has resulted from that hospice fraud?
Speaker 5
Certainly. We've heard several heartbreaking stories. Several of them have involved people signed up for hospice or their loved ones signed up for hospice without their knowledge. We talked to one woman whose brother had had a stroke, was not entirely mentally capable, so was living in an assisted living type of situation. People came by and seemed nice to him, seemed like they wanted to befriend him, got him to sign up for hospice, gave him a 40-inch TV, and then he was signed up for hospice benefits, which, when he then came out with a serious illness that required hospice several months later, threatened his ability to get signed up for appropriate hospice to actually treat the illness, which he was then diagnosed with terminally.
Speaker 1
When a fraudulent claim is paid out, whether to a bad actor in a hospice or in home health or in durable medical equipment or any other sector. What is CMS recovery rate on those dollars that go out?
Speaker 5
Unfortunately, it's very low. We don't have an exact estimate, but I would say probably 10 percent, which is why we need to shift our approach.
Speaker 1
That's nominal compared to what it could be if we stop the money from going out in the first place. Since CMS has turned the spotlight on certain states, increasing the necessary oversight, have fraudulent claims decreased?
Speaker 5
Well, as I mentioned, I can't speak to the specific states because most of those efforts are relatively new. But with our fraud detection operations center that I mentioned in my oral testimony, we have stopped over $2,100,000,000 from going out the door just since March.
Speaker 1
I thank you for your vigilance on behalf of the patients who are being defrauded, on behalf of the taxpayers who are paying for this. We appreciate the efforts. We look forward to working with you. I now recognize the ranking member of this committee, Miss Clark, for her five minutes of questioning.
Speaker 2
Thank you very much, Mr. Chairman. In addition to the billions of dollars that CMS is threatening to cut off to Minnesota, the agency has initiated investigations in California, Maine, and, most recently, New York. Miss Brandt, which individuals at CMS were involved in the decision to select these particular states, and what was the process?
Speaker 5
Thank you for your question, Miss Clark. The answer is that his entire team of people within the center for program integrity.
Speaker 5
a data-driven approach. We are constantly using heat maps and data analysis to be able to look and see where we think the largest shifts are. For instance, in Minnesota, what we saw was an increase in the adult companion service providers by over 131% with a corresponding increase in Medicaid payments of 234%. While the number of actual beneficiaries remained fairly stagnant, at around an increase of just 24% during that period of time.
Speaker 2
You mentioned that you were one of the individuals involved in the decision. Were you personally involved in drafting, reviewing, and approving the.
Speaker 2
Yes. Administrator Oz has indicated that other states will receive similar inquiries from CMS. Can you confirm administrator Oz's public comments that other states should expect letters from CMS?
Speaker 2
And what data is CMS using to determine which state should be investigated, and how many more does it intend to investigate?
Speaker 5
We use the Medicaid data, the TMSIS data, which is reported by the states, and we mine that data. It also has recently become publicly available, so others can mine it as well. And that is the data that we use to be able to decide where to focus. I cannot give you an exact answer on the number of additional states because that will depend on what the data shows us.
Speaker 2
Other states are understandably watching how CMS is treating Minnesota. In January, CMS notified the state of Minnesota that the corrective action plan to address health care fraud was insufficient, and the agency was prepared to withhold more than 500,000,000 in quarterly Medicaid funding. The state requested a hearing on CMS's decision on January 9. It is now March 17, and the CMS has still not scheduled a hearing about these massive cuts. When will the hearing be, and why has it taken CMS this long to schedule it?
Speaker 5
In answer to your question about when the hearing will be, we have been stayed from actually planning the hearing because of subsequent litigation that the state initiated against the agency.
Speaker 2
While this process remains stalled, Vice President Vance and CMS administrator Oz announced that Minnesota will be subject to an additional Medicaid funding deferral of $260,000,000 a quarter, or up to a billion dollars over the next year. The state also asserts that CMS has not provided specific details that would justify this deferral. Did CMS staff conduct a full audit of quarterly Medicaid, excuse me, Medicaid claims from Minnesota before making the decision to defer nearly $260,000,000 of reimbursements to Minnesota's state Medicaid agency? Yes. In fact, that number was reached after a very thorough financial review of the CMS-64 forms, which
Speaker 2
How long did it take? How long was the audit? How long did it take to do that audit?
Speaker 5
I don't recall exactly how long, but it would have been between 30 to 60 days.
Speaker 2
Why has CMS refused to fully explain and discuss the deficiencies you have found in the audited claims with the state of Monas, Minnesota?
Speaker 5
That is incorrect because our team has been meeting with the state on a regular, ongoing basis. We get weekly data feeds from the state, and up until a week ago, had been having weekly calls with the state, and, in fact, have sent teams to the state three different times to.
Speaker 5
If you will. There has been ongoing discussion about their corrective actions, what they're doing, and the timeline by which they are going to complete those actions.
Speaker 2
So these further deferral actions on top of what has already been withheld, is, or what, is it a motivational thing? What is it? Why is that required if you're in a negotiation?
Speaker 5
So there are two separate actions, ma'am. The first is a financial audit based on claims submitted that they need to be able to look at to show that there is financial justification and appropriate documentation for how it is that they are going to be able to show why the claims that they submitted need to be reimbursed at that level. The second is an ongoing discussion about program integrity actions, which is separate and distinct from the financial piece.
Speaker 1
The ranking member yields. The chair now recognizes the chair of the entire committee, Mr. Guthrie, for his five minutes of questioning.
Speaker 3
Thank you, Mr. Chair. And it still amazes me. We're not all here unified, just amazed at the fraud that we're uncovering, and it just robs people who need Medicaid. And so doctor Oz recently said that in South Florida, and I know you just sent a letter to South Florida. I don't know Florida.
It was a state that President Trump won, if I'm correct, and the Republican there who's a friend of mine is governor. I mean, it was the governor's Republican, which they said they only do for one Democrat governors. That's just not accurate. So doctor Oz recently said that in South Florida, there are twice as many durable medical equipment companies as there are McDonald's. In LA County, California, 89 hospice companies are registered to a single address in Van Nuys.
Are there patterns? So I don't know why this doesn't offend everybody, but I don't know. This is a different world that appears here. Are there patterns in geographic concentration of Medicare fraud that CMS is seeking and tracking, or seeing and tracking?
Speaker 5
Absolutely. In fact, we see very different geographic patterns and pockets across the country. South Florida has traditionally been a hotbed or epicenter of fraud. One of the reasons that the McDonald's stat that doctor Oz is so fond of remains accurate. The fact of the matter is there's always a high number of durable medical equipment suppliers in that area, largely because you have a beneficiary population that is not always as familiar with the benefit.
English is not their first language. They are more easily taken advantage of by these fraudsters. And so, as a result, we see a higher percentage of all types of fraud. Similarly with Los Angeles, with Texas, particularly Harris County and other parts of southern Texas, we see the migratory patterns to many other areas of the country. Hospice, home health, and durable medical equipment are the top three areas that we typically see this happening.
And when we shut it down in one area, it's like whack-a-mole. It pops up in another.
Speaker 3
Thank you. So, also, CMS has historically relied upon a pay and chase model, processing claims first, and pursuing fraudulent payments later. Given that recovering funds from bad actors is often costly, time-consuming, and/or unsuccessful. Can you walk us through what CMS is doing to shift resources towards prepayment review and front-end fraud detection?
Speaker 5
Absolutely. We're using a variety of tools for this, and this is one of the things that I am personally most excited about, having done this for several years and had to spend time chasing after that money. We can now stop it on the front end. And we're doing it not only through the war room that I described earlier, where we're looking at the most egregious providers, at least five a day. And we've managed, as I mentioned before, to stop over $2,000,000,000 to date.
We're also now using new algorithms that we can get using machine learning and artificial intelligence to be able to run edits, to be able to stop payments from going out the door. Some of the new edits that we have used, we are able to see millions of dollars a week that we are able to stop before those claims even get paid. And that's where it's going to make a huge difference going forward.
Speaker 3
So in the last hearing we had on this, the minority brought a witness that tried to define difference between fraud and improper payments. And saying these were improper payments, not necessarily fraud, that's what the witness was trying to bring forward. If you have 89 hospice companies registered to one address in Van Nuys, California, what is the probability that's not fraud?
Speaker 5
It's a very low probability, would be my estimate. And what we've seen is when we go to validate that, it ends up being that the majority of them are fraudulent. These are not improper payments. An improper payment is when you have a documentation error or when you have something that is billed incorrectly. Fraud is when you are deliberately and intentionally seeking to defraud the federal government.
And that's what we're seeing in these companies that have 80 plus in one building, and where people are taking advantage of our most vulnerable citizens.
Speaker 3
So that's what you said. When you defraud the federal government, you're defrauding the taxpayer, and you're defrauding the people who receive these benefits.
Speaker 5
You're hurting everyone. The more dollars that go away from our ability to take care of people like in the house that I described in Florida or in California we saw last week, that's dollars that should be taking care of them, not dollars that should be going overseas or to fraudsters to buy houses on the beach.
Speaker 3
Well, I know California does, I pointed out Florida does have a Democrat governor, but people should still be offended by this fraud. Wouldn't you say?
Speaker 3
So how does the Fraud Defense Operations Center work? I got 30, we got half a minute to kinda explain.
Speaker 5
Sure. The way it works is we get a mix of fraud investigators, lawyers, law enforcement, HHS OIG, DOJ, medical professionals altogether, and we look at the data. Again, it's all data-driven. We look at real-time Medicare claims data and determine where we see big spikes in the data. So, for instance, on skin subs, last year, one of the cases we saw was an 89-year-old woman who had showed that she had had 5,029 claims for skin subs submitted on her behalf, and she was on hospice.
So, obviously, that's a pretty clear indicator of fraud.
Speaker 5
That would be fraud. And she would be mummified if that was actually the case. And so at the end of the day, what we're looking to do is to use the fraud defense operation center to go after these and to determine where we're seeing things like genetic testing or other types of emerging frauds, so that we can stop them before they become a bigger issue. Catheter fraud is a great example of that. You may recall that issue.
CMS was actually able to stop over 90% of that before it even went out the door. And that was huge because that was billions of dollars that was being organized by deliberate groups that were seeking to defraud the government and send that money overseas.
Speaker 1
The gentleman yields. The chair now recognizes the ranking member of the entire committee, Mister Palone, for his five minutes of questioning.
Speaker 4
Thank you, Mr. Chairman. I heard, my chairman Guthrie say that he wanted us to be unified, but I have to tell you that's very difficult with doctor Oz at the head of CMS. I don't know why he isn't here today, to be honest. But in all honesty, I don't trust him. I don't think he acts in good faith.
And I think he's just a grandstander who likes to go on TV, but doesn't really do anything, you know, substantively that's meaningful to help Medicare and Medicaid recipients. So I just wanna lay that out. I'm being honest. I'm gonna use Minnesota as an example of what I just said. CMS sent a letter to Minnesota on 12/05/2025, reminding that the state takes certain steps, including submitting a corrective action plan by 12/31/2025.
And then Minnesota discussed its planned corrective action plan with CMS on December 30, which was New Year's Eve, and then submitted it on the following day, which was the deadline provided by CMS. Minnesota then met with CMS on January 6, you know, about a few days later. And according to the state, CMS did not provide Minnesota any substantive feedback on the corrective action plan at that meeting. But later that day, Doctor Oz went on Fox News to announce that CMS would withhold $515,000,000 in Medicaid funding per quarter. That's about 20% of the state's Medicaid funding.
And called Minnesota's proposed corrective action plan, and I quote, completely insufficient, while complaining that it was sent to him on New Year's Eve. So Minnesota basically submits a corrective action plan on the deadline that CMS gives them. And then only two business days later, Doctor Oz trashes it, of course, by going on Fox News and grandstanding on TV. This is my point. This is what he does.
Now, Miss Brandt, who reviewed the corrective action plan in the two business days between December 31 and January 6 that I mentioned, determined that it was, as Doctor Oz said, completely insufficient, as he told Fox News. Who reviewed it in those two business days?
Speaker 5
A team of program experts from the Center for Program Integrity and the Center for Medicaid and CHIP Services.
Speaker 4
Okay. In those two business days between Minnesota submitting its corrective action plan and CMS issuing its noncompliance notice, did CMS provide any substantive feedback to Minnesota or give Minnesota any opportunities to amend it before withholding more than half 1,000,000,000 in health care funding?
Speaker 5
To be clear, no funds were actually withheld as a result of the corrective action plan until we had a chance to thoroughly review it. The 259,000,000, which was referenced by your colleague, the ranking member, is actually what the actual funds were that have been withheld. Doctor Oz said that CMS could take action to withhold up to 500,000,000 that you're referencing, but no actual action was taken at that time until we reviewed the corrective action plan in more detail. And then I personally sent an email back to the state about a week later, after January 6, giving them detailed feedback on the corrective action plan. And then doctor Oz and myself, along with a couple of other people, went and met with the state in person.
Speaker 4
Alright. That was after the TV grandstanding. Now, historically, CMS is only with health funds as a last resort if a state is refusing to cooperate with the agency. But it seems to me that Minnesota did a lot, and you were still meeting with them, as you said, after Dr. Oz was on TV. And then, in December, on the December 5 letter that you sent, you asked that Minnesota provide weekly updates to CMS, impose a six-month moratorium on hire providers, establish off-cycle revalidation for all provider enrollments, and submit a corrective action plan.
It appears to me that Minnesota did all these things. My whole point is he goes on TV, he says within two days that this plan is insufficient. Okay. You met with him a few days later, but it wasn't long before, you know, before the ax came down. And that's not what normally happens.
So let me ask you, do you agree that Minnesota took all four steps that you requested in your December 5 letter?
Speaker 5
As I mentioned to the ranking member, I would distinguish between the two actions. The corrective action plan and the program integrity actions that you were discussing that were the subject of the December 6 letter were focused on program integrity guardrails and the various issues that they needed to take to ensure that they were making appropriate payments. The CMS 64 financial audits, which is based on actual deliverables and actual receipts provided by the state to CMS, is what is the focus of the primary.
Speaker 4
I don't buy it. I think the CMS is not working in good faith with Minnesota, and I worry that CMS is going down the same path of weaponizing health care funding for states and governors that the president doesn't like or is feuding with. That's what's happening. But I yield back, Mr. Chairman.
Speaker 1
The gentleman yields. The chair now recognizes a gentleman from Texas, Mr. Weber, for his five minutes of questioning.
Speaker 7
Thank you, sir. Deputy administrator, we're glad that you're here. How long have you been in this role?
Speaker 7
Yeah. Yeah. You seem very knowledgeable about this. I appreciate that. I wanna talk about my own home state of Texas.
And in the home in Texas, $65,000,000 was paid in fraudulent Medicare claims related to genetic testing that was never requested on behalf of the beneficiaries. What have you, it seems like you're aware of that. Have you observed with respect, have you referred to their lab schemes that's involving fraudulent or unnecessary lab testing? How do you get to that? What's the process?
Speaker 5
It's very difficult, sir, and we have observed it. In fact, as I mentioned to you with our fraud detection war room that we have, the 1,800,000,000 we stopped last year, a 100,000,000 plus of it was related to just those types of laboratory services. And, unfortunately, what that means is then when those services get billed, even if they're not provided, they go on the patient's medical record, and it precludes them from being able to get that type of testing in the future, when they might need it for a cancer diagnosis or something more serious.
Speaker 7
So our great citizens are the brunt of that, really, while the thieves are making away with the taxpayer dollars.
Speaker 7
I appreciate what y'all are doing. Programs like Medicare and Medicaid are designed, as we would say, for the most part. For the most vulnerable populations in our country, such as the elderly. These populations are also the most given to health care scams, as you well know. Given the essential role CMS plays in our health care system, how do you educate some of those elderly population to stay away from those scams?
Speaker 5
It's a great question. Something we are continuing to work on even more. Right now, we have several different things. We've been doing various videos that doctor Oz has been posting, telling people, if you see something, say something. Call 1800 tips.
Call 1800. Contact your senior Medicare patrol. The hospice fraud that we've been looking at in Los Angeles, a big part of how we've been able to really successfully go after it is because we are partnering with the state officials for the senior Medicare patrol and for the organizations that are protecting Medicare and Medicaid beneficiaries in LA, and really using them to help us identify where this fraud is occurring and to then educate their members and the beneficiaries they serve about what to do. It's really important to us that seniors understand that they should not fall victim to these schemes or give their information out to people. It's when they do that these types of harm occur.
Speaker 7
Well, your lips to God's ears. I appreciate y'all doing it. This is just to me, I'm just a simple guy. I owned an air conditioning company business for 35 years, but math I can do. Seems like you ought to go to the states, and you ought to say which ones are the first you're gonna look at.
You look at the number of the population. Look at the number of Medicaid. I'm talking about the whole population in the state, the Medicaid recipients, the amount of federal and state tax dollars being spent on Medicaid dollars, and then the method of recovering, if any, of the fraudulent dollars. CMS claims by state. Identify the first state.
You doing that? Are you giving states priority to build, you have the most amount of fraud in said state? How do you do that?
Speaker 5
It's a combination of things. As we mentioned, or as I mentioned earlier, we really do use a data-driven approach. For instance, some of our recent actions which led to the letter to New York state was because in New York, what we found was that their spending for Medicaid beneficiaries was 36% higher than the national average. And we were trying to get a better sense why that is, particularly because of the fact there were several particularly fraudulent types of services such as adult daycares, which seem to be funneling a lot of these dollars away from legitimate ones.
Speaker 7
You know, you'll have daycares in Minnesota. They get paid millions of dollars for keeping care of kids, and they don't. Did I say that out loud?
Speaker 5
And they also have autism services where there were kickbacks of several thousand dollars paid to patients or to parents for bringing their children in to claim they had autism and to seek those services, were never provided.
Speaker 7
So how do you, and so when you say New York was 36% higher than the other, yeah.
Speaker 5
The average spending on each beneficiary for New York Medicaid is 36% higher than the national average.
Speaker 5
Well, that is why we sent them a letter, and we are hoping to get a response so that we can better understand, using the information they provide, why that's happening. I will say with Minnesota, we've been able to come to a much better understanding of what some of the issues were that drove that spike in spending, and we're working with the state to hopefully get better program integrity safeguards.
Speaker 7
Yeah. Well, there's a lot of waste, fraud, and abuse out there, isn't there? And all.
Speaker 5
It's not just out-and-out fraud. There's also a lot of waste, people billing for services that are at a higher level than necessary. There's also a lot of abuse in that people are just taking advantage and billing for things that just aren't necessary at all. And then that puts beneficiaries at harm, too.
Speaker 7
Well, thank you. Our most vulnerable Americans are paying that price, aren't they? Mister chairman, I yield back.
Speaker 1
The gentleman yields. The chair now recognizes a general lady from Massachusetts, Miss Trehan, for her five minutes of questioning.
Speaker 8
Thank you, Mr. Chair. So rooting out fraud in Medicaid and Medicare is essential. It protects patients. It preserves the integrity of these programs and ensures taxpayer dollars are spent on the folks in our communities who actually need the help. That's something I think every member on this committee can agree on.
And central to that mission is the HHS Office of the Inspector General. The OIG identifies fraud. It investigates cases and serves as a critical watchdog over these programs. It seems like a valuable position, as we talk about fraud, waste, and abuse. That's why it remains so confusing to so many of us why Donald Trump unilaterally fired the HHS inspector general immediately after taking office, contradicting his claim that combating fraud is a central goal of this administration.
Not only did the president move the leading official for detecting fraud in Medicare and Medicaid, but he left the role unfilled for almost an entire year, then fill it with a partisan loyalist. Miss Brant, the HHS officer inspector general, recovered roughly $30,000,000,000 for taxpayers since 2020 by identifying fraud, waste, and abuse in Medicare and Medicaid. If combating fraud is truly a priority for this administration, why remove the independent watchdog responsible for recovering those billions, and replace them with a partisan loyalist?
Speaker 5
I was not involved or responsible for that decision, so I cannot speak to that. But I can tell you that the HHS OIG is a valued partner of us at CMS and our fight against health care fraud, and we work with them every day.
Speaker 8
And we sort of trust that those watchdogs are going to be independent. Now I've seen the chairman's letter to Massachusetts regarding our MassHealth program. I want to be clear, fraud cases should absolutely be investigated and prosecuted. And here's the thing, the cases that are cited in that letter, we know about them precisely because Massachusetts has strong safeguards in place. Our system identifies fraud.
We hold bad actors responsible, and we work to close the door on future abuse. That's a system that's working. That's what good oversight looks like. And if this committee is serious about fraud, and I hope it is, then consistency and enforcement matter. And that means we shouldn't just be targeting a handful of states that happen to have Democratic governors.
We need to shine a light on the actions of this White House, too. Miss Brent, do you know who Lawrence Duran is?
Speaker 8
Well, mister Duran pleaded guilty to stealing $87,000,000 from Medicare and was sentenced to 50 years in prison for his crimes. But in May, Donald Trump commuted his sentence. Are you aware of that, Miss Brandt?
Speaker 8
In fact, president Trump has pardoned or commuted the sentences of multiple individuals convicted of defrauding federal health care programs. Philip Osformes, who was convicted of orchestrating one of the largest Medicare and Medicaid fraud schemes in history, stealing approximately 1,300,000,000 from these programs, had his sentence commuted by president Trump. President Trump also pardoned five individuals convicted of stealing roughly $35,000,000 from Florida Medicaid's program. William Keo, Todd Farha, Thadius Barade, Paul Barron, and Peter Clay. These cases involved large-scale fraud against taxpayer-funded health care programs intended to serve seniors, people with disabilities, and low-income families.
And the president of the United States freed every single perpetrator of those crimes. It's maddening. I will close with this. Protecting Medicare and Medicaid from waste, fraud, and abuse is one of the most important things this committee can do. If this committee is serious about that effort, we're here to work together on strong solutions like strengthening provider screening in Medicaid, addressing how some Medicare Advantage insurance gained this payment structure by overdiagnosing patients to inflate reimbursements, and targeting the areas experts have flagged as the highest risk.
Not what we're doing by targeting the democratic states. Thank you, and I yield back.
Speaker 1
The general lady yields. The chair now recognizes the gentleman from Georgia, Mr. Allen, for his five minutes of questioning.
Speaker 9
Thank you, Chair George, for holding this important hearing. I wanna thank the witness for testifying and your good, precise answers to these questions. Obviously, the rising cases of fraud within Medicare and Medicaid is causing significant burdens for millions of American patients and seniors. That's why I'm glad we're having this hearing to explore solutions to the cost of care for Americans, and I thank you for your willingness to do such a great job of analyzing this. And, I don't guess you made any of the recommendations to President Trump of those pardons, did you?
Speaker 9
Ask you? Okay. Deborah, Brent administrator Brent, when we talk about Medicare and Medicaid fraud, can we get caught up in the sheer dollar amounts, get to the real beneficiaries that are harmed in many of these cases? You talk about the harm that fraud causes to those beneficiaries out there who truly deserve this, what Congress intended for, Medicare Medicaid.
Speaker 9
Little loud. Sorry. Yeah. Can you tell us who really has been adversely affected by this fraud in Medicaid. In other words, those who deserve the care, who have not gotten the care because someone is defrauding medicare absolutely.
Speaker 5
Hundreds of thousands of beneficiaries are impacted by this every day. We see this with people who are contacted about getting, for instance, a motorized scooter when they might enjoy having a motorized scooter, but they don't meet the requirements for actually needing a scooter. And then they get it, but then when they actually need a true wheelchair that is needed for their medical condition, they have already used their limit of being able to get that type of device. Those are the types of things that we see all the time: fraudsters take advantage of these people. Chairman Guthrie was asking about genetic testing.
A great example, a lot of these people will call beneficiaries, ask them for their Medicare number. Unfortunately, the beneficiaries give it to them, and then they send them a test that isn't even a real test. It's not even a COVID test, maybe. And then as a result, it says on their medical record that they've received this genetic test. So when they need it to be able to determine if they have markers for cancer or other things, they are no longer able to get it.
And we have to work to clean their record of that for them to get it, and that costs time.
Speaker 9
Well, our constituent services team in the 12th District of Georgia is well aware of that because we're getting tons of denials. And so what you're saying is that's fraudulent denials in most cases.
Speaker 5
In many cases, the denials are fraudulent, or they're because there isn't appropriate documentation to show that it's meeting the level of service that it's being billed for.
Speaker 9
There are documented cases of state Medicaid officials failing to follow federal requirements to independently monitor the Medicaid program. What authorities do CMS have to address states that fail to follow federal, statutory, and regulatory requirements in the Medicaid program?
Speaker 5
So CMS is required to ensure that states and the providers that work with states follow all of the requirements for those programs.
Speaker 9
What tools does CMS currently have to ensure states are meeting program integrity requirements?
Speaker 5
That is an area site. Yeah. That is an area where we continue to work with the states. Traditionally, we've done audits of state billings both at the provider level, and then we've done financial audits of the state-submitted financials, which are the CMS 64 audits that I referenced earlier. But most importantly, we work with states to ensure that they're doing things like screening providers appropriately, making sure that they're doing their own audits, and doing their own reviews to ensure that claims are paid properly.
And then we're working to create, by the end of the year, a 50 state Medicaid program integrity playbook, which hopefully will have best practices from across all 50 states to help states be able to learn from each other about what's really working well in some states, so that the states who don't have as great resources can hopefully implement some of those ideas.
Speaker 9
Well, thank you so much for your service to our country and to this agency, and the great work that you're doing there. And, you know, I'm behind you 100%, so keep up the great work. Thank you. Thank you. I yield back.
Speaker 1
The gentleman yields. The chair recognizes a gentleman from Oklahoma, Mister Mullen, for his five minutes of questioning.
Speaker 10
Thank you, Mr. Chair. Thank you, Deputy Administrator Brent, for appearing. We all wanna combat fraud where it exists. Yet CMS's unprecedented action withholding up to $2,000,000,000 from Minnesota's Medicaid program is deeply troubling to me. Thousands of individuals within the state are at risk of losing access to essential services that the state cannot finance on its own.
Your agency cut entire categories of services in Minnesota. As I understand it, it didn't target specific providers. It didn't target specific claims. Most disturbingly, there's nothing that indicates your agency put thought toward how those cuts would impact the public itself. So before it moved to withhold up to $2,000,000,000 from Minnesota, did CMS complete any analysis of how many seniors, children, or people with disabilities would lose care if the funding was withheld?
Speaker 5
So, in fact, we did a detailed financial analysis of that through our Centers for Medicaid and CHIP Services and determined that there were adequate funds in Minnesota to be able to sustain the continuity of care if we were to withhold the entirety of the money. In fact, we only withheld 260,000,000 to date.
Speaker 5
It happens within the financial group, the financial management group within CMS, and our Medicaid services.
Speaker 10
On January 27, CMS sent a letter to my home state of California launching its investigation of Medi-Cal, the state's Medicaid program. Using the same tactics used against Minnesota, CMS is targeting programs that provide critical services, including early childhood intervention for kids with autism and in-home care for the elderly and disabled. I'm extremely concerned that CMS is using the pretext of rooting out fraud to defund these essential services. For seniors in particular, these services are the difference between whether they can live and age at home, instead of an institution. One senior in my district wrote to me saying, quote, for families like mine, these programs are not just a safety net.
They are a lifeline. Given how CMS has handled Minnesota's Medicaid program, I'm worried that you're about to withhold billions of dollars of funding from California next without any real justification, due process, or an effort to protect vulnerable patients. So, Miss Brant, before CMS issued its January 27 letter to California, which I have a copy of, did CMS conduct any assessment of how many Californians receive care through the programs that you deem as high risk for fraud and what the impact would be if you withhold funds?
Speaker 5
We did an analysis of how many beneficiaries were receiving those in California. And what we determined was for the in home supportive services or the IHSS services that we targeted in the letter, part of our concern was that over a ten year period of time, California had experienced a 340%. Sorry. Tongue-tied there. 348% increase in spending for those services without a correlatively equal rise in the number of people receiving those services, which is what prompted our desire to send the letter.
Speaker 10
But you do believe that the impacts of withholding Medicaid funding, particularly when it comes to possibly limiting patients' access to services, should be considered before doing so.
Speaker 5
À 100%. In fact, one of the things that I have stressed throughout my testimony today and that we continue to have as a guiding light at CMS is the whole goal of our fraud and abuse efforts is to make sure we are keeping money to be able to provide services for the seniors who need it. The example I gave in my oral of the people in California that we saw in the residential home where they were getting $36,000 per month from the Medi-Cal program for people to be living in squalid conditions. That's unacceptable. They deserve better, and we as taxpayers deserve better.
Speaker 10
We are all against fraud. Let me be very clear about that. That's not what this is really about, I'm afraid. I will continue to stand against these extreme actions that are selectively targeting estates with democratic leadership. My constituencies are better than to have their lifesaving health care used as a political pawn.
With that, I yield back.
Speaker 1
The gentleman yields. The chair now recognizes a gentle lady from Tennessee, Doctor Harshberger, for her five minutes of questioning.
Speaker 11
Thank you, mister chairman, and thank you for being here today. What recourse does CMS have to stop or pause suspicious payments that are attributable to fraudulent claims before they're paid?
Speaker 5
We actually have a great deal of authority in that regard, and we're exercising it more than ever. In fact, as I mentioned a couple of times, we've been using it through the fraud war room, but we're also now using it, for instance, for these types of entities that the chairman mentioned in his opening statement where you have multiple entities existing within a single office building or when you have areas with an extraordinarily high number of potentially fraudulent entities. Our goal is to suspend payments until we can determine those are legitimate services, and that's an important tool.
Speaker 11
So, huge red flag. Huge red flag. So, what authorities does CMS have to direct states to recoup fraudulent Medicaid payments? Because I've talked to HHS about this.
Speaker 5
Yeah. So, we have a few authorities. Again, if we can determine that a state has had payments that have gone out for inappropriate payments. In fact, a couple of recent audits we had, we found hundreds of those instances. We go to the state, and we point it out to them, and they have to recoup it either from the providers or pay it back directly.
Speaker 11
What are the chances they're gonna recoup any of that money, though? If you've got deceased patients, deceased providers that they are fraudulently billing, Harry gonna recoup that?
Speaker 5
Well, that's why we're trying to go to stop and caught versus pay and chase, ma'am. That's the real focus of that. We wanna use data analysis and more advanced analytics to really be able to look at the data. Our challenge on the Medicaid side is the data that we have is state-reported Medicaid data, which is often three to four months old and doesn't allow us to be able to see it.
Speaker 11
That's exactly right. How does CMS coordinate with federal and state partners, including HHS, Office Inspector General, the Department of Justice, and state Medicaid fraud control units, and other law enforcement entities when investigating those fraud schemes?
Speaker 5
We operate in lockstep. Part of the war room is that we have all those people in the same room.
Speaker 5
Talking with each other so that we can actually impose a payment suspension on the spot. If we see something in the data analysis that day, we can put a stop to it immediately, and then our law enforcement partners can possibly even start investigating that day. And that's a huge shift from where we used to be.
Speaker 11
Yeah. I mean, how do you have everybody in the same darn office building and following these claims? It's just, you know, it goes to my next question. How CMS is working with law enforcement to crackdown on transnational criminal perpetrators of Medicaid and Medicare fraud? And that is one.
Speaker 5
Of the more tricky areas that we work on. As we've seen, unfortunately, there are foreign entities that have infiltrated the country by buying sham operations. Many of these buildings that we know of that have multiple entities in them that do not appear to be real entities, yeah. Are owned by various foreign national interests. And as a result, we've been working very closely with law enforcement to determine, oh, are those legitimate or not?
And then if so, to hopefully stop any payments from being made, because once they go out the door, they get funneled back overseas, and it's nearly impossible for us to catch them.
Speaker 11
Yeah. Yeah. It's almost impossible to recruit recoup anyway. Program integrity efforts vary significantly from state to state. Are there best practices from certain states that you can highlight that CMS believes should be adopted more broadly?
Speaker 5
Absolutely. In fact, part of the goal of a lot of the letters that we've sent out and the reason we asked the questions we did is because we wanna develop a 50 state playbook by the end of the year. Yeah. Which will highlight a lot of these best practices, and help us understand which states are able to use things. The states where their data shows that there's high instances of fraud, what is it that's working? What is it that's not working?
And how can we help them to learn from others, or how can we help other states to be able to build better safeguards? That's the goal.
Speaker 11
Yeah. You don't have to reinvent a wheel. Just do it right. And we got states that are doing it right. Let me make sure I've got the time.
Does CMS have the capability to use its data to flag anomalies, such as 89 hospital companies registered to the same building in Van Nuys, California? And if CMS has the capability, what actions are taken to determine whether the company's registered in that billing are legitimate businesses?
Speaker 5
So we do two things. We do data analysis to watch what types of billings are happening for those entities. And then secondly, we do on-site visits to determine if they are real. On-site visits there. And the on-site is highly intensive and requires a lot of resources, but they pay dividends because what we've seen is where we do them, we have high rates of revocations.
Yeah.
Speaker 11
I don't tell people when I'm showing up to do something either, so it's better to keep it secret. I've got 14 seconds. What Medicare provider and supplier categories are experiencing the most fraud today? Well, it was until January six subs. That was our biggest area that we had seen huge growth, but now.
Speaker 11
Yeah. I got that because I get complaints every day about it. So thank you, and I yield back.
Speaker 1
The general lady yields. Votes have been called. We will recess the hearing and reconvene 10 minutes after the last vote. The subcommittee stands in recess. Clark?
I'll even share my pretzels with you. I'll even share my pretzels.
Speaker 1
The committee will now reconvene. The chair now recognizes the gentleman from New York, Mr. Tonko, for his five minutes of questioning.
Speaker 13
Thank you, Mister Chair, and thank you, Ranking Member Clark. Thank you, Miss Brent, for joining here. During his State of the Union address on February 24, President Trump announced that Vice President JD Vance would be leading the so-called war on fraud. The next day, CMS administrator Oz appeared at a press conference alongside vice president Vance and said, and I quote, the president announced last night that he is appointing our vice president to lead the war on health care fraud, a wise choice. Minutes later, however, the president vice president announced that he was, quote, tightening the screws, unquote, on the state of Minnesota, a major action against the state's Medicaid program.
Since then, the administration has attempted to narrow the vice president's role. In a 03/09/2026 filing in federal district court, the Department of Justice stated that, and I quote, Vice President Vance holds no delegated Medicaid-related authority, unquote, and characterized his posturing as nothing more than political rhetoric. So on one hand, the administration told the federal district court that the vice president is just playing politics. On the other hand, President Trump and Administrator Oz said that Vice President Vance will be leading the administration's anti-fraud efforts. So, Miss Brett, given the contradiction here, I'm hoping you can clear this up for us.
What role does Vice President Vance play in CMS's anti-fraud efforts?
Speaker 5
Well, for the regular fraud efforts are led by doctor Oz as our administrator of CMS, and then, obviously, the vice president as the head executive within the office of the president, as designated by the president, works very closely with doctor Oz to coordinate those efforts.
Speaker 13
So, with that being said, what actual authority does Vice President Vance have in relation to CMS's anti-fraud work?
Speaker 5
Well, again, working in the executive office of the president, he helps work with all Senate-confirmed political appointees, including Doctor Oz.
Speaker 13
Well, let me ask some specific questions here to try to get some clarity. Was Vice President Vance involved in deciding any of the actions that have been taken against Minnesota?
Speaker 5
CMS has been directly involved in working with the state to advance those actions.
Speaker 5
Not in the day-to-day. But, again, in his advisory role from the White House, he remains involved in all of our anti-fraud efforts.
Speaker 13
So was Vice President Vance involved in selecting the states of California, New York, Maine, or Minnesota for the CMS inquiries that were sent over the past months?
Speaker 5
As I stated earlier, those decisions were driven entirely by data analysis performed by CMS based on the spending and the number of beneficiaries in those states, and what we determined to be program integrity weaknesses.
Speaker 13
So how does he function within that whole framework, then? If he is involved with some substantive assignment? I mean, some of these calls seem like, as you're indicating, they're made by CMS, by Dr. Oz. But so at what point does he enter, and what is his role? What is his responsibility?
Speaker 5
He's been designated by the president to serve as the departmental-wide, agency-wide, government-wide lead on anti-fraud efforts. And as such, our office, as well as all other offices across government, is coordinating with him in the new office that he has been entitled to head to work on efforts to crush fraud across the whole agency, not just in health care.
Speaker 13
So can he challenge any of the decisions made by Doctor Oz if he's the agent of anti-fraud?
Speaker 5
Many of our efforts have predated when the vice president was named to that role. As you said, that was just in the State of the Union three weeks ago, and a lot of our efforts have been ongoing since well into last year.
Speaker 13
So is that gonna slide over to his assignment area rather than Doctor Oz, or are they gonna be doing something?
Speaker 5
Committed at CMS to doing health care fraud. The vice president has been named to head fraud across all government entities and agencies, of which CMS is obviously one. We will continue to do our part and our responsibility to safeguard the 170,000,000 Americans and 1,800,000,000,000 in CMS.
Speaker 13
Well, does he have involvement then in selecting future states for CMS inquiries or investigations?
Speaker 5
CMS will continue to be the one to make data-driven and fact-based determinations as to which states we will act upon, and we will notify the vice president as part of his new responsibilities. But we will be the ones who will continue to drive that using our fact-based, data-driven approach.
Speaker 13
Well, I've had a number of other questions that I'll get to you via the subcommittee, but just trying to define his role here. So with that, yield back, Mr. Chair.
Speaker 1
The gentleman yields. The chair now recognizes the gentleman from Idaho, Mr. Fulcher, for his five minutes of questioning.
Speaker 14
Thank you, Mr. Chairman. Miss Brant, thank you for your testimony today and just the overall information flow, which is very, very helpful. This hits home for me and for Idaho. There was a significant highly visible case in the northern part of our state where there was a conviction of a physician that was falsely billing for medical equipment, mainly for durable medical equipment. And, as a function of that, just a couple of questions.
When Medicare or Medicaid fraud is convicted, or a fraudster is convicted, does the DOJ claw back any of those proceeds?
Speaker 5
Yes. In fact, the Department of Justice helps determine what type of restitution is needed in those cases. It can be up to what they call treble damages or three times the amount of what was stolen from the programs.
Speaker 14
So do you have any idea how much may have been collected over the last, say, 5 years or whatever period of time you might be aware?
Speaker 5
I can't speak to the totality of the five years, but I can tell you that each of the last years, the Department of Justice with the partners at OIG and then entities like CMS and the FBI have collected billions of dollars, and each year the amount gets even greater.
Speaker 5
It's fair, but it's better than not having it recovered. But we'd rather not have it begin with.
Speaker 14
Yeah. I understand. Let's talk about financial institutions for a second. Do you think that financial institutions, first of all, do they have an obligation to report any suspicious activity that could be linked to Medicare or Medicaid that you're aware of?
Speaker 5
It's a great question. Actually, something where we have been recently working very closely with our colleagues at the Department of the Treasury focused on just that, how we can help make it so that banks can let us know when they see suspiciously large deposits or when new accounts are open that have large dollars associated with them. It helps us to know that those might be the subject of health care fraud, and then we can monitor the payments to them. So, yes, banks have a responsibility. Much like the average person, if they see something, they should say something.
Speaker 14
But there’s not an obligation, but you’re thinking that that might not be a bad idea to require it.
Speaker 5
I'm not aware of a direct obligation, but we have been working with them to ensure that there is certainly a moral obligation.
Speaker 14
Great. Okay. Thank you. Does CMS conduct greater scrutiny on providers who specialize in durable medical equipment? That's the issue that we had in my state.
Was primarily with that, like prosthetic devices, orthotics, that type of thing.
Speaker 5
Well, durable medical equipment is consistently one of our highest areas of fraud. As I mentioned, just with the war room that we've had of the 1,800,000,000 we stopped last year, 1.5 of it was related to durable medical equipment. In general, durable medical equipment is one of our highest rates of improper payments and fraud of all the categories of payments that we have across CMS.
Speaker 14
You notice trends in different demographics, where you're catching into some of these major fraud activities. You need common themes for the demographics.
Speaker 5
Yes. There are. In fact, just, again, as I mentioned, I've been doing this now for twenty years through three tours at CMS. And when I started, it was wheelchair fraud. Back in the day, everybody was getting a wheelchair.
Everybody that saw an ad on TV called in, and they could get a wheelchair. And that was a multibillion-dollar fraud. More recently, we've seen frauds in durable medical equipment involving things like continuous glucose monitors, CPAP machines, or other types of durable medical equipment where they're either prescribed unnecessarily or given to people that don't actually need them.
Speaker 14
Listen. Thank you for your work, and once again for your input. And, mister chairman, I think that does it for me. I yield back.
Speaker 1
Gentleman yields. The chair now recognizes the gentleman from Ohio, Mr. Balderson, for his five minutes of questioning.
Speaker 15
Thank you, Mr. Chairman. Thank you for being here, deputy administrator. Appreciate that. Deputy administrator, Brent, are you provider verification methods such as identity verification, fingerprinting, unannounced site visits, and background checks an effective tool to reduce the enrollment of fraudulent providers?
Speaker 5
We have found them to be a very effective tool. And in particular, the on-site visits and doing the background checks, especially the fingerprinting, have helped us to be able to find unsavory characters participating in our programs.
Speaker 15
Thank you. Is CMS using technical tools to improve and streamline provider enrollment?
Speaker 5
We are. In fact, as I mentioned in my beginning statement, we have a really cool series of algorithms that we're now using that operates like Netflix. So it'll say, Congressman Balderson, you really like to watch action movies. And as a result, this allows us to put all the bad actors that we have had, that we've taken action against, into this algorithm. And then as a new enrollee comes in, we run them against it.
And much like Netflix tells you what movie to watch, it tells us these are high-risk people. You wanna keep an eye on them. And as a result of that, we've been able to do more targeted site visits, more targeted follow-through along the types that you were mentioning, and be able to kick out an even higher percentage of people within the first six months of their participation.
Speaker 15
Thank you. I'll follow up to that. If so, do you have an estimate of cost savings that have resulted from CMS using these tools?
Speaker 5
So far with our enhanced site visits, we've been able to assume at least $250,000,000, just over the past couple of months for using these enhanced site visits to be able to keep out providers, and we hope eventually it will be in the billions.
Speaker 15
Thank you. Across many states, Medicaid providers have been found billing for services supposedly delivered to patients who were deceased, hospitalized, incarcerated, or confined to living abroad. For example, in Massachusetts, a transportation company billed for nearly 17,000 rides, including 100 for patients already confirmed dead. In Colorado, a defendant billed 165,000 for rides to a beneficiary who had passed. In New York, investigators identified 25 transportation companies billing for rides for patients confirmed deceased or hospitalized.
What mechanisms does CMS currently have to cross-check active claims against death records, hospital admission records, and incarceration records before approving payment?
Speaker 5
Well, I can speak primarily to the deceased individuals that you referenced, sir, in that we have a data matching agreement with SSA to be able to do a cross-reference to something called the death master file. And into the death master file, all of the localities report all of this. And as a result, we were able to run both providers and beneficiaries against that to not only ensure that we aren't paying for dead people, but we aren't paying dead people. And that is what we do on the federal side. On the state side, it's more complicated because for states, they each have to do that on their own.
So I can't speak to what each state would do, and that is responsible for several of the cases you just referenced.
Speaker 15
Okay. Thank you. Federal law enforcement has documented a pattern in which foreign organized crime networks deliberately seek out and purchase already enrolled legitimate Medicaid Medicare, excuse me, provider businesses such as durable medical equipment companies, which we just talked about previously, specifically because these businesses carry active billing credentials, clean payment histories, and established relationships with Medicare. Because in this situation, fraud begins after acquisition rather than during enrollment, standard provider screening does not detect it. What federal requirement currently exists, if any, that obligates revalidation of providers in the course of ownership changes?
And is that requirement equivalent in rigor to what is applied at initial enrollment?
Speaker 5
It's a great question and one that we are working to continue tightening up. Currently, there is a three- or five-year revalidation requirement, meaning that any supplier or provider in the program has to revalidate their credentials on either a three- or five-year basis depending on the type of entity they are. If they have a change of ownership, they are required to report that to us, and they have to do that. I believe that's within 6 months. I am not recalling the exact time frame, but there is a requirement that they have to give us the change of ownership notification.
And then from there, we follow up. One of the things that has been most challenging is that many of these entities use Shell corporations or Shell entities. And even when we cross-reference them, they look like they're legitimate entities. So under our new Crush RFI, the comprehensive regulation for uncovering suspicious health care, we're asking for comments until March 30 on just those types of things. Should we do higher surety bonds?
Should we have more rigorous screening provisions? What should we do to make sure to further clamp down on the change of ownership? So we welcome you and everyone to give us your comments on that.
Speaker 1
The gentleman yields. The chair now recognizes a gentle lady from Texas, Miss Fletcher, for her five minutes of questioning.
Speaker 16
Well, thank you, Chairman Joyce, and thanks to you and Ranking Member Clark for holding today's hearing. Thank you, Miss Brant, for your time today. As I've said before, I think that this subcommittee in particular has an important job to protect our communities and the rights of our fellow citizens, including by making sure that the executive branch is doing what it should, is not overreaching, and is not violating the rights of Americans. And on that point, I have serious concerns around how Americans' personal information is currently being used or misused in the federal government. And we've seen a few lawsuits and some recent reporting on the issue of citizens' data being used improperly by federal government employees, particularly in connection with the DOJ effort and Elon Musk.
And on March 6, the Social Security Administration's inspector general notified some members of Congress that it's reviewing a whistleblower complaint related to the potential misuse of Social Security Administration data by a former DoD employee. The Washington Post reported that this investigation stemmed from a whistleblower complaint that a former DoD software engineer at the Social Security Administration claimed to have retained copies of sensitive databases filled with personal information on almost every living American. It is hard to describe. I don't know that I have the words to describe what an incredible abuse of power it is. But the unfettered access to American sensitive personal data that we have seen by officials in this administration, particularly by the Doge staff, is incredibly alarming.
And the firewalls that I've understood to be in place between agencies and preventing access to information seem to have come down. So just last month, Doge decided to post a whole database of CMS Medicaid provider spending without clear guardrails on its use or an explanation of its limitations. And the HHS Doge's Twitter slash X account said that using this dataset, it would have been possible to easily detect the large-scale autism diagnosis fraud seen in Minnesota. That dataset has since been pulled down, with the website saying now that it's being updated. So, Miss Britt, I wanna ask you about this in particular.
Did you approve of this Medicaid dataset being posted or assist Doge with collecting and posting this data in any way?
Speaker 5
Are you referring specifically to the HHS data that you just referenced?
Speaker 16
To the dataset of CMS Medicaid data that DOGE posted. Were you involved in that collection of data or approving that?
Speaker 5
No. I was not involved in the collection or the approval of the posting.
Speaker 16
Okay. And do you agree with their statement that large scale fraud was easily, and they said easily, detectable using the dataset. And if you do agree with that, then why didn't CMS catch it? I would
Speaker 5
Agree that data can be used to find those types of fraud. I couldn't comment on how easily that is available. I can say that our team used the same datasets to be able to drive a lot of our program integrity oversight that we have been doing. And we also discovered that there were issues with autism fraud both in Minnesota as well as elsewhere in the country.
Speaker 16
And so in that process, if you didn't approve the Doge folks collection or use of this, and it may be true that you can use datasets. Of course, I think we would all agree with that, that data and having fact based evidence and data is what we need to use to make decisions. Did anyone in the Doge effort at HHS consult, to your knowledge, ask about how this was used, or why safeguards that data are so important? Because putting it out there on X seems like not what we should be doing with sensitive data without any guardrails. I mean, was there any awareness on your end that something like that was going to happen with their access to this data?
Speaker 5
Again, I can't speak to what Doge knows or doesn't know or how their decision-making process works, but I can tell you that at CMS, we take very seriously our privacy responsibilities and our responsibility to make sure that we are safeguarding people's data.
Speaker 16
Well, and I appreciate that, and that is absolutely essential to your charge. Americans across the country are trusting that when they share this information, whether it's with CMS, whether it's with Social Security, or whether it's with the IRS, that this data is protected. And I think you've answered my next question. You're not aware of what has been shared with Doge, but you agree with me that there are safeguards that exist to prevent it from misuse, and this committee should make sure that those safeguards are followed.
Speaker 16
Okay. Well, I have used up my time, so I thank you very much for your testimony. And, Mr. Chairman, I yield back.
Speaker 1
General lady chair yields. The chair now recognizes a gentleman from Georgia, Mr. Carter, for his five minutes of questioning.
Speaker 12
Thank you, mister chairman, and thank you for being here, deputy administrator. Miss Brent, professionally, I'm a pharmacist. So I've dealt extensively with Medicaid and Medicare, and particularly with reimbursement having on my own business for so many years, thirty two years. And I know that, firsthand, how important the dollar spent and making sure that they are appropriately spent to support legitimate care for the patients who truly need it. Unfortunately, we've seen a lot of fraud schemes, and they continue to evolve.
And they often target areas of a program where reimbursement is high or oversight may be more challenging. One area that's seen dramatic growth in Medicare spending in recent years has been the use of skin substitute products for wound care. It's very important. We need that. We need skin substitute products for wound care, but what we've seen is obviously been out of control.
And I applaud the agency for addressing that. But these products do play an important role in treating chronic wounds. And the rapid spending growth, as I say, and the unusual billing patterns have raised concerns that some providers might be overutilizing these products or billing for services that may not be medically necessary. Can you ask me this? Medicare claims for skin substitutes, since they've grown so dramatically, what are the most common waste, fraud, and abuse indicators that CMS has identified in this area?
Speaker 5
Well, what we've seen is an exorbitant rise in the number of claims submitted for those. I gave an example earlier, but in the fraud war room, we've actually seen numerous examples of beneficiaries who have had thousands of skin substitute claims submitted just for one beneficiary, which would mean that was practically impossible. They would be covered in skin cells. It's been.
Speaker 12
And I would agree it has been. But, again, there's we gotta be careful because it is important. We don't want amputations, particularly in patients. As we all know, diabetic patients, if you get a wound on their lower extremity, that's gonna be awful, and it's gonna result in a lot of times an amputation. But, what kind of countermeasures is CMS implementing to reduce the wasteful and sometimes medically unnecessary use of the skin substitutes?
Speaker 5
Well, there's a couple of different things that we've done because we agree with you. We want the people who need those services to be able to get them. I have family members who are diabetic who have had wounds that required those. I know how vitally important they can be. However, what we've done is we changed the payment structure for skin subs, which, starting January 1 under the new payment rules, we've seen a 99% reduction in billing for skin subs.
We have not seen a correlative rise in people coming to us and saying they don't have access to skin subs. We've also done letters to hundreds of skin subs providers where we sent them letters saying, hey, Dr. Carter. Did you know that your billings were 10 times more or four times more than those of your colleagues are? You should just be aware that we're keeping an eye out for it. As a result of those letters that we sent out, we had an over 60 percent rate of people just dropping out immediately and not billing for skin subs anymore.
The remainder stopped billing for everything, stopped billing for skin subs, but kept billing for everything else.
Speaker 12
And that's great. And I applaud you for that. That's what you ought to be doing. That's what we're expecting you to do. Do we have any results in seeing more amputations?
I mean, is there any way how we are ever gonna quantify that?
Speaker 5
So we have not seen a correlative rise in the number of people that need or are expecting to receive skin substitute, as a result. And as I said, once we have changed the payment structure as of January 1, we have received, to my knowledge, no pushback from the beneficiary community saying that they don't have access to being able to get that care. We, you know, continue to work with and would obviously respond if those beneficiaries would come forward and could point to us where those problems were occurring, and then we would obviously revisit our approach. Okay. Because right now, we're good.
Speaker 12
Okay. Well, I know you find it hard to believe, but I got a bill that addresses this.
Speaker 12
It is the Skin Substitute Access and Payment Reform Act, and it would modernize the payment system for skin substitute products. I'm just worried we swung the pendulum too far. I know it's gotta swing back, but I I'm just scared we may have swung it too far and that we're gonna get adverse effects as a result of that. But it, my bill puts an end to runaway prices and inappropriate prescribing by implementing new program integrity reforms and ensuring that patients in need receive affordable, accessible, and high quality care. So I invite all of my colleagues to sign on to it.
I hope y'all will look at it, and I know that the agency is. I've been in touch with them, and we're trying to address this. Just I'm running out of time, but I wanna also mention in my practice of pharmacy, I was very involved in hospice care. And I can tell you I saw the proliferation of hospices as a result of overbilling and just the fact that there was a lot of problems in that area. So I appreciate your attention to that as well.
Speaker 12
Well, and please understand. I'm not criticizing you on the skin products. I'm just saying we gotta find a happy median there. Okay? Understood.
Thank you so much. You. I yield back.
Speaker 1
The gentleman yields. The chair now recognizes the general lady from Washington, doctor Shrior, for five minutes of questioning.
Speaker 6
Thank you, Chairman Joyce, and Ranking Member Clark. And thank you to our witness for being here today to take our questions. I'm really glad that we're discussing fraud. It is an issue that we all want to crack down on. Fraud and abuse hurts patients, hurts honest providers, and, of course, hurts taxpayers.
And this is not a partisan issue. Fraudsters need to be prosecuted. But the reality is that right now, fraud is being weaponized by Republicans to mainly target states run by Democrats. And recently, the energy and commerce Republicans sent a letter to my state of Washington with questions about fraud in our Medicaid program, which, by the way, our state caught. Mister chairman, criminals should be prosecuted whether they're in blue states or red states.
We need equal opportunity prosecution of fraud, and I am so ready to work with you to make sure we are rooting out fraud everywhere. But it turns out that other than when it's politically convenient, this administration has actually made it much harder to investigate fraud in Medicare and Medicaid. Just four days into his presidency, President Trump illegally fired 17 inspectors general, the very people responsible for rooting out fraud and abuse in government programs. These are the watchdogs who protect taxpayers. He's also pardoned several criminals convicted of ripping off taxpayers and committing health care fraud, and here are just a few.
Lawrence Duran pleaded guilty to stealing $87,000,000 from Medicare. Miss Brandt, does that sound like fraud to you?
Speaker 6
He pleaded guilty. President Trump, who Republicans keep referring to in this committee hearing as the president who is waging the toughest ever crackdown on fraudsters, pardoned him. Philip Asformis was convicted of stealing $1,300,000,000 from Medicare and Medicaid. Does that sound like fraud to you? Again, if he was convicted.
He was convicted, indeed. Well, it turns out President Trump commuted his 20-year sentence. And then, a whole group, William Kale, Todd Farhad, Fadius Baraday, Paul Barons, and Peter Clay conspired to steal $35,000,000 from Florida's Medicaid program, and they were convicted. Miss Brandt, again, does this sound like fraud to you?
Speaker 6
And, again, President Trump pardoned them. There is a definite pattern here. And so I'm wondering about this pattern, Ms. Brandt. What message does it send to or would be fraudsters when they see the president of the United States pardon people convicted of stealing money from taxpayers?
Speaker 5
I certainly can't speak to the president's actions because I'm not involved in those at all. But what I can say is that at CMS, we have been focused from the very first day of the administration on going out to our health care front.
Speaker 6
The question's a little different. What message does it send? This is not a comment about what the president did, because we all just heard that he pardoned fraudsters. What message does it send to other potential criminals or to other fraudsters or potential fraudsters when they see fellow fraudsters being pardoned by the president?
Speaker 6
Okay. I think everybody listening could draw their own conclusions about what that message might send. And then, of course, what do you think about President Trump's decision to fire the nonpartisan HHS inspector general and then wait a whole year to replace him with a partisan HHS inspector general with his own history of ethics violations?
Speaker 5
Again, I can't speak to the president's actions, but I can say that we partner very closely with the HHS Inspector General's office.
Speaker 6
I'm glad that you do, and thank you for making sure that you do that and making sure that you do that in a bipartisan manner and crack down on fraud in all states. I just wanna say that when I think about this, this new inspector general, maybe he's doing his job, maybe he's doing it fairly. But I will tell you that as we are hearing about this so-called president who is cracking down on fraud, the stories that we are hearing about pardoning fraudsters sure do not sound like a president cracking down on fraud. It sounds like a president who sweeps fraud under the rug. I have 30 seconds left, so I'm just gonna mention the WISER program.
This is a pilot program that CMS launched earlier this year that essentially is using AI to bring in prior authorization to traditional Medicare. It's been a disaster, by the way, in Medicare Advantage, and has specifically been modeled to deny or delay coverage to seniors. And, I am just going to express that AI can be used and dialed up for good or for bad. And I am very concerned about bringing the WISER program into traditional Medicare because the incentive structure will be used to deny care because they're incentivized in terms of payment to be paid according to how much they save or do not pay out or do not offer services to seniors. So please reconsider, and I have a letter to you asking for that very thing, to not implement the WISER program.
Thank you. Yield back.
Speaker 1
General lady yields. The chair now recognizes a gentleman from Ohio, Mr. Lanzman, for five minutes of questioning.
Speaker 17
Thank you, Mr. Chair. And, I'm gonna ask about something totally different, not fraud. But I have a constituent and a very close friend, who has EB. And, he and I have been working on a bill that would ask for a study so that we can get the data back on, ensuring that everyone who has EB, it's a rare disease that affects the skin, and you can't you need to
Speaker 17
Yeah. I apologize. No problem. It's oftentimes referred to as the worst disease you'd never heard of. It's the butterfly disease where the skin just does not work right.
I'm sitting next to a pediatrician, so pardon my language. You know, I or my
Speaker 17
But I, in terms of explaining it, yeah, it's a rare disease that affects the skin. In any event, the bandages are incredibly expensive, and families spend a lot of money. Our bill, which is named after him, Shane, would help families pay for that, entirely because it does one, they need it, but two, it reduces infections and hospitalizations and ultimately saves Medicaid money. So CMS has focused a lot this year on waste, fraud, and abuse, especially in the wound care space. CMS even removed the local coverage determination for skin substitutes to curb high spending.
We talked a little bit about that, or you have. A patient like Shane requires the use of very expensive bandages just to keep him comfortable and has very few alternatives for care. Really nothing else. Wound care alone for an EB patient can be millions of dollars per year, making it more difficult for EB patients to get the treatment they need. So our bill, again, would create a two-year pilot program at HHS to study the cost of Medicaid, paying for wound care to reduce hospitalizations for EB patients.
Just a couple of questions. One, do you know what the annual cost of these bandages would be for Medicaid to cover an EB patient?
Speaker 5
Well, first of all, I'm very sorry for your friend and the challenges he and his family have. I do not know the cause of that, sir, but I would be happy to follow-up.
Speaker 17
That would be we just wanna work together on this. Do you have a sense of what the challenges would be that come from providing hospital-level care for a patient that has significant wound care needs?
Speaker 5
We certainly have seen at CMS several examples of people who have challenging needs that need additional coverage, and that's part of why we always try to factor that in when we're making coverage decisions.
Speaker 17
Would it be cost-saving to provide the wound care needs to these patients rather than pay for the hospitalizations due to lack of care?
Speaker 5
I don't know the exact dollars, so I can't speak to it. But, again, be happy to follow up with our team and talk to your staff.
Speaker 17
And then lastly, what would it take for CMS to launch a pilot program to study the impact of providing wound care to EB patients and preventing hospitalizations? I mean, we have the bill, but I'm just curious.
Speaker 5
I think we would be happy to look at what that would take and follow-up with your staff to provide any input that we could.
Speaker 17
K. Shane, there are lots of young people that have this, is an incredible human being, one of the smartest, bravest people I've ever met in my entire life. And he's been an advocate for rare disease work and EB his entire life. He's had, like, 150 surgeries. I mean, he's been through everything, he's battling cancer probably for the last time.
So this would be really important, to try to get as much traction on this as we can, and so we'll follow-up with your team.
Speaker 5
I'll make sure my team follows up with you. And, again, best wishes to you and your friend.
Speaker 1
I go back. Gentlemen Yields, seeing that there are no further members wishing to ask questions, I would like to thank our witness again for being here today. I ask unanimous consent to insert in the record the documents included on the staff hearing documents list. Without objection, that is so ordered. Pursuant to committee rules, I remind members that they have 10 business days to submit additional questions for the record. And I ask that the witness submit their response within ten business days upon receipt of the questions.
Members should submit their questions by the close of business day on Tuesday, March 31. Without objection, the subcommittee is adjourned.
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