CMS Medicaid Fraud War Room Stops More Than $203 Million in Improper Payments During First 88 Days
50 high-risk providers identified through coordinated federal, state enforcement actions
The Centers for Medicare & Medicaid Services (CMS) announced that enforcement efforts from its Medicaid Fraud War Room (MFWR) stopped more than $203 million in potentially improper Medicaid payments in just under 90 days, highlighting significant progress in protecting taxpayer dollars and strengthening Medicaid program integrity. Since its launch on April 23, the MFWR has coordinated actions against 50 unique, high-risk Medicaid providers identified through advanced data analytics and representing more than $203 million in Medicaid payments subject to federal exclusions and state enforcement efforts.
“Every dollar lost to Medicaid fraud is a dollar taken away from vulnerable Americans who rely on it,” said CMS Administrator Dr. Mehmet Oz. “In just under 90 days, the Medicaid Fraud War Room has proved that these losses aren’t inevitable and has shown Americans what we can accomplish with robust federal-state partnerships, advanced data analytics, and a real sense of urgency. We’ve made significant progress toward crushing waste, fraud, and abuse, but we’re not done yet. If you steal from Medicaid, we will track you down, cut you off, and work to ensure that every taxpayer dollar we spend funds quality care for eligible beneficiaries.”
To date, MFWR activities have resulted in:
- Forty-two Federal Notices of Intent to Exclude providers from federal healthcare programs were issued by the U.S. Department of Health and Human Services Office of Inspector General (OIG), representing approximately $160.7 million in Medicaid payments since January 1, 2025.
- Fifteen state enforcement actions were taken against providers based on MFWR referrals, representing approximately $46.2 million in Medicaid payments since January 1, 2025.
- Seven of these providers were subject to both federal and state action, meaning that 50 unique providers have been identified, representing approximately $203.3 million in Medicaid payments since January 1, 2025.
“The Medicaid Fraud War Room is what modern program integrity looks like: federal and state partners working off the same data, in real time, to stop bad actors before more taxpayer dollars go out the door,” said CMS Deputy Administrator and Chief Operating Officer Kim Brandt. “Fifty providers and $203 million in just 88 days is not a coincidence — it’s the result of tighter coordination, better analytics, and a workforce that treats fraud prevention as core mission work, not an afterthought.”
The MFWR was established in coordination with the White House Task Force to Eliminate Fraud and brings together CMS, OIG, state Medicaid agencies, and federal law enforcement partners to identify and rapidly address high-risk providers.
Building on the success of CMS’s Medicare Fraud Defense Operations Center, the MFWR uses advanced analytics to identify suspicious billing patterns, generate investigative leads, and coordinate rapid enforcement actions across federal and state partners.