Crushing Fraud, Waste, & Abuse
CMS is crushing fraud, waste, and abuse to protect Americans.
Announcement: Crushing Fraud Chili Cook-Off Competition
CMS is announcing the Crushing Fraud Chili Cook-Off Competition, a market-based research challenge aimed at harnessing explainable artificial intelligence, specifically machine learning models, to detect anomalies and trends in Medicare claims data that can be translated into novel indicators of fraud. This challenge also seeks scalable analytic and policy solutions designed to target and address these high-risk areas within the Medicare program.
The Chili Cook-Off kicks off on August 19, 2025. CMS invites research proposals from all interested parties. See here for further information about the challenge or to submit your proposal.
CMS ACCOMPLISHMENTS
JANUARY 1, 2025 - JULY 31, 2025
OVERPAYMENT PREVENTION
CMS imposed 265 Medicare payment suspensions on providers
Over $1.5 billion in payments are on hold following payment suspension
Through medical review activities, CMS fraud contractors identified $1.3 billion in overpayments across 1,856 Medicare providers
Automated edits guarding against improper payments and potential fraud have denied payment for over 700,000 items or services, totaling over $124 million.
CMS revoked the ability of 3,392 providers and suppliers to bill the Medicare program due to inappropriate behavior.^
INVESTIGATIONS AND REFERRALS
CMS Referrals Accepted by Law Enforcement
Law enforcement accepted 213 CMS fraud referrals for potential legal action
These referrals encompassed $1.9 billion in billing
The most powerful tool to combat fraud is YOU. So far in 2025, 1-800-MEDICARE has received complaints related to fraud, waste, and abuse from over 160,000 beneficiaries—that’s over 700 calls each day! If you suspect fraud, report it at CMS.gov/fraud or by calling 1-800-MEDICARE.
^ This data encompasses FY2025 (October 1, 2024 – most recently available data)
Page Last Modified:
08/19/2025 03:59 PM