00:00For too long, the government fought health care fraud the old-fashioned way.
00:04We sent out the money first and then spent years trying to get it back.
00:07That's not prevention. That's plain catch-up.
00:10COVID exposed just how vulnerable that system had become.
00:13Criminals learned they could steal taxpayer dollars with far too little risk.
00:17At CMS, we decided no more.
00:20So we built a technology-powered fraud prevention operation
00:23that stops bad actors before taxpayer dollars ever leave the door.
00:27The results are historic.
00:28In fiscal year 2025, CMS protected $42 billion in Medicare funds,
00:35the largest fraud prevention savings in the program's history.
00:38That's nearly a 60% increase over the previous year.
00:42Even more important, nearly 70% of those savings came from preventing fraud before it happened,
00:48not chasing criminals after the money was already gone.
00:51Using advanced data analysis and AI,
00:54we're connecting the dots against billing patterns in real time.
00:57We're no longer looking at one suspicious claim at a time.
01:00We're identifying entire fraud networks and shutting them down.
01:04When we uncovered widespread abuse in home health and hospice,
01:08we suspended more than 800 providers,
01:10stopped billions of dollars in suspicious billing.
01:13We took a similar approach when durable medical equipment suppliers
01:16charged the federal government billions in fraudulent claims.
01:19That's a big red flag.
01:21With no time to lose,
01:22we revoked and suspended billing privileges for more than 800 DME suppliers,
01:27effectively wiping out this type of fraud within just six months.
01:31That's what a strong prevention strategy looks like in practice.
01:34When we noticed a sharp uptick in backfilling for skin substitute claims,
01:38with 2025 dates of service,
01:40we once again took swift action.
01:42CMS denied nearly all,
01:44about 96%,
01:45of the suspicious skin subclaims that came to us.
01:48Because it turns out,
01:49they simply weren't legitimate.
01:51And when the president demanded an all-of-government approach to crush fraud,
01:55we partnered with the vice president's White House Anti-Fraud Task Force
01:58to get it done.
01:59We also brought all 50 states together
02:01to revalidate high-risk Medicaid providers,
02:04making it much harder for fraudsters to simply move across state lines.
02:08Here's the bottom line.
02:09Every dollar we stop from being stolen
02:12is a dollar that stays with seniors,
02:14people with disabilities,
02:15and the taxpayers who earned it.
02:17Government doesn't have to be slower than the criminals.
02:19With the right technology,
02:21the right strategy,
02:22and the resolve to act,
02:23we can stay ahead of them.
02:25And that's exactly what CMS is doing.
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