The Centers for Medicare & Medicaid Services prevented more than $1.6 billion in fraudulent Medicare laboratory payments since the start of the second Trump administration, the agency announced Friday.
Highlights of enforcement actions taken by the agency include saving $732 million from 157 providers revoked from the Medicare program; more than $500 million in potentially fraudulent payments from 185 suspensions from 600 labs; more than $276 million from 442 identified overpayments and $127 million in potentially fraudulent payments from law enforcement referrals.
“When laboratories bill Medicare for tests they never performed, it drains the Medicare Trust Fund and diverts resources away from beneficiaries who need them,” said Mehmet Oz, M.D., CMS administrator, in a statement. “That's why, under the leadership of the White House Anti-Fraud Task Force, CMS has built a technology-powered fraud prevention operation to root out scammers all across our health care system, from laboratory testing and hospice care to medical equipment and autism therapy. We won't stop until we've restored program integrity and ensured that fraudsters have nowhere left to hide.”
CMS said savings were the result of advanced analytics usage, including artificial intelligence and machine-learning models. The agency has identified and targeted several types of laboratory fraud, including billing for medically unnecessary services to patients with no established relationship with ordering providers.
In fiscal year 2025, CMS fraud prevention efforts resulted in $42 billions in savings. For fiscal year 2026, the agency has thus far identified $1.8 billion in Medicare overpayments, collected $378 million in overpayments and suspended more than $539 million in suspected fraudulent payments.
Moreover, the CMS Fraud Defense Operations Center has accounted for more than $371 million in Medicare suspended payments involving 267 providers and suppliers since Jan. 1.
Reducing healthcare fraud, especially in Medicaid and Medicare, has been a priority for the Trump administration in recent months.
U.S. Health and Human Services (HHS) Secretary Robert F. Kennedy Jr. announced in July CMS would defer approximately $867.5 million in federal Medicaid payments to California and $199 million from Minnesota.
CMS announced in May that $1.3 billion would be held from California, which Oz said was the largest deferral ever made by the agency. Similar actions were announced against Minnesota in February.