The Centers for Medicare & Medicaid Services (CMS) announced a new set of program integrity actions on February 25, including a decision to defer $259.5 million in quarterly federal Medicaid matching funds to Minnesota tied to the state’s fourth quarter fiscal year (FY) 2025 spending. CMS said the deferral is intended to prevent payment of “questionable claims” while further review is completed, citing $243.8 million in “unsupported or potentially fraudulent” claims and $15.4 million related to claims involving individuals the agency says lacked satisfactory immigration status. In describing the basis for its review, CMS referenced “unusually high spending and rapid growth” in certain service areas, including Home and Community-Based Services (HCBS). 

Alongside the Minnesota action, CMS is launching what it is calling the Comprehensive Regulations to Uncover Suspicious Healthcare (CRUSH) initiative, including a nationwide call for the public and stakeholders to support fraud prevention efforts and provide ideas for strengthening oversight. Shortly after the announcement, CMS released a Request for Information (RFI) seeking input on potential regulatory or policy changes that could be incorporated into a future rulemaking, explicitly inviting feedback from states, providers, suppliers, payers, patient advocates, beneficiaries, and technology companies. 

 CMS also announced a six-month nationwide moratorium on new Medicare enrollments for suppliers in certain categories of Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS). The agency describes this as a preventive step aimed at curbing improper billing in a high-risk area, while it evaluates additional safeguards. (ANCOR)