CMS Administrator Mehmet Oz addresses healthcare fraud allegations

Centers for Medicare and Medicaid Services (CMS) Administrator Dr. Mehmet Oz has addressed two distinct areas of suspected healthcare fraud. Regarding the Affordable Care Act, Oz suggested that the fact approximately 35% of current enrollees have never used their coverage is evidence of fraud. However, CMS clarified in a recent rule that “zero utilization is not, on its face, indicative of an unauthorized enrollment,” noting that young, healthy, or low-income enrollees often go months without filing claims.

In a separate matter, Oz reported a scheme in Minnesota where fraudsters allegedly bribed mothers with roughly $1,500 per child to falsely claim autism diagnoses. Oz stated that CMS examined 14 high-risk programs in Minnesota and found that roughly one-third could not be validated. The agency is pursuing dozens of cases and has deferred approximately $500 million in payments to the state. This follows reports of significant growth in Minnesota’s autism program, which rose from $3 million in 2018 to nearly $400 million in recent years.