Crushing Fraud, Waste, & Abuse
CMS is crushing fraud, waste, and abuse to protect Americans.
Alert: Probationary prior authorization for certain DMEPOS items begins October 15, 2026
Probationary prior authorization for certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) items begins October 15, 2026, for newly enrolled DMEPOS suppliers and those undergoing certain changes of ownership. Additional information can be found here.
CMS Reports Highest Program Integrity ROI Ever Recorded
Due to the bold actions this administration has taken to crush fraud, CMS delivered unprecedented results in Fiscal Year (FY) 2025, protecting taxpayer dollars and holding bad actors accountable like never before.
Total Medicare program integrity savings surged 59%, from $26.3 billion in FY 2024 to a record-shattering $41.9 billion in FY 2025. The FY 2025 Medicare Return on Investment (ROI) reached $22.3 to 1, up from $14.6 to 1, the highest ROI ever.
More information can be found here.
Program Integrity Demonstrations and Initiatives Map
View the Centers for Medicare & Medicaid Services Fraud Defense Operations Center video here.
Fast Facts
Learn more about program integrity risks to CMS programs and the steps CMS is taking to crush fraud.
The MFWR
The FDOC
Hospice Fraud
FY 2025 ROI
Fraud Spotlights
See below for details on the biggest risks to CMS programs.
DMEPOS Suppliers
DMEPOS is a frequent target of fraud, and CMS is taking significant actions to crack down on fraud committed by DMEPOS suppliers.
Through its current and planned future actions, CMS intends to ensure that only qualified and legitimate DMEPOS suppliers participate in the Medicare program.
Fraudulent Genetic Testing
Fraudulent genetic testing schemes divert resources from beneficiaries by submitting claims for medically unnecessary tests supported by falsified documentation and illegal kickbacks.
CMS is committed to identifying these schemes and stopping improper payments before they occur.
Enrollment Moratoria
CMS is continuing its broader crackdown on fraud by imposing nationwide Medicare enrollment moratoria focused on high-risk providers, including home health agencies and hospices.
The moratorium on certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) suppliers ended August 27, 2026.
Medicaid High-Risk Services Spotlight
See below for the biggest risks to the Medicaid program.
Applied Behavior Analysis (ABA)
Applied Behavior Analysis (ABA) is an intensive behavior therapy for individuals with autism spectrum disorder (ASD) and other conditions that can improve outcomes, especially at younger ages. ABA therapy focuses on learning and reinforcing acceptable behaviors with a goal of minimizing problematic behaviors and reinforcing positive behaviors.
Early intervention that includes ABA can improve cognitive functioning and language skills but should not be viewed as the only appropriate treatment for ASD.
Adult Day Care (ADC)
Adult Day Care (ADC) programs can provide a safe environment for older adults with trained staff in an ADC center. An ADC center may offer social activities, exercise, meals, personal care, and basic health care services, although variation exists and there is no singular definition of ADC.
Some will provide transportation — the facility may pick up the person, take them to day care, and then return the person home. Charges can be hourly or by the day. Medicare does not pay for ADC, but Medicaid and other government programs may provide coverage.
Personal Care Services (PCS)
Personal care services (PCS) are provided to eligible beneficiaries to help them stay in their own homes and communities rather than live in institutional settings, such as nursing facilities.
PCS are categorized as a range of human assistance provided to persons with disabilities and chronic conditions to enable them to accomplish activities of daily living (e.g., eating, bathing, dressing) or instrumental activities of daily living (e.g., meal preparation, hygiene). An independent or agency-based personal care attendant (PCA) may provide these services in the beneficiary’s home or at other locations.
Page Last Modified:
09/01/2026 04:13 PM