(June 5, 2026): Amid the publicity and fanfare of a White House Press Conference on February 25, 2026, Vice President J.D. Vance, Secretary Robert F. Kennedy[1], and Administrator Mehmet Oz, M.D.,[2] announced a new Medicare and Medicaid program integrity initiative known as the Comprehensive Regulations to Uncover Suspicious Healthcare (CRUSH).[3] Secretary Kennedy framed the initiative as a decisive departure from the agency’s Pay and Chase model. Moving forward, the Centers for Medicare and Medicaid Services (CMS) intends to employ a real-time Detect and Deploy approach that uses Artificial Intelligence (AI) tools to detect fraud and prevent improper payments. Initial steps taken at the time of the announcement included freezing $259 million in Medicaid funding to Minnesota (pending the completion of an ongoing fraud investigation); the imposition of a nationwide moratorium on Medicare enrollment for certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) suppliers; [4] and a nationwide call for Americans to support fraud prevention and for stakeholders to provide input on how CMS can enhance its fraud prevention efforts. [5] The CRUSH Initiative is not limited to Medicare. CMS has tied the initiative to broader concerns about Medicaid, CHIP, and the federally facilitated exchange (also referred to as the “Marketplace”). Although CMS has not yet finalized a comprehensive CRUSH regulation, on February 27, 2026, the agency published a Request for Information (RFI) in the Federal Register seeking stakeholder feedback on potential regulatory changes to enhance its ability to combat fraud.[6] In this article, we examine several broad steps CMS has taken since the CRUSH Initiative was first announced and discuss the impact these efforts may have on your home health or hospice agency.
I. Overview of the Administration’s Fraud Enforcement Efforts:
The initiation of CMS’s February 2026 CRUSH program efforts can be traced to broader executive-branch efforts to intensify program-integrity enforcement across federal health care programs. On June 6, 2025, the White House issued a Presidential Memorandum titled Eliminating Waste, Fraud, and Abuse in Medicaid, directing the Secretary of the Department of Health and Human Services (HHS) to take action against abusive state-directed Medicaid payment practices.[7] Shortly thereafter, on July 2, 2025, representatives of the U.S. Department of Justice (DOJ) and various HHS agency representatives formed a new False Claims Act Working Group that is tasked with strengthening the government’s efforts to combat healthcare fraud.[8] Even more recently, on March 16, 2026, President Trump issued an Executive Order titled Establishing the Task Force to Eliminate Fraud. The Executive Order created a Task Force to Eliminate Fraud within the Executive Office of the President, chaired by Vice President Vance, that includes representatives from HHS and DOJ as members.[9]
II. CMS’s Administrative Enforcement Efforts in 2025:
CMS’s 2025 integrity reporting shows a strong emphasis on screening, data matching, payment suspensions, revocations, and automated claim controls. During calendar year 2025, CMS and its program integrity contractors were extraordinarily active in administrative enforcement.
| Program Integrity Enforcement Tools [10] | Actions Taken in 2025 |
|---|---|
| Administrative Suspensions Imposed Against Medicare Providers and Suppliers (42 C.F.R. §405.371) [11] | 537 |
| Amount of Medicare Payments Placed on Hold Due to Administrative Suspension | $5.7 billion |
| Number of Medicare Provider / Supplier Revocation Actions Taken (42 C.F.R. §424.535) [12] | 5,586 |
| Number of Medicare Claims Denied Through the Use of Automated Edits | 1.2 million |
| Number of Prepayment Claim Denials Due to Failure to Meet Medical Necessity Requirements | 122,658 |
| Amount of Postpayment Overpayments Collected | More than $371 million. |
| Fraud Reports Received at 1-800-MEDICARE | More than 307,000. |
| Referrals Accepted by Law Enforcement | 372 referrals, representing $3.7 billion in billing to the Medicare program. |
CMS’s CRUSH Initiative is merely the latest program by the agency to identify and eradicate improper billing practices and fraud by providers and suppliers. Medicare-enrolled providers and suppliers should expect faster detection of irregular billing practices, faster initiation of audits, less tolerance for documentation deficiencies, and a closer examination of ownership and business affiliations.
III. Overview of CMS’s CRUSH Initiative -- Request for Information (RFI):
At this time, the primary policy document associated with CMS’s CRUSH Initiative is the Request for Information (RFI) published in the Federal Register on February 27, 2026. In this initial RFI, CMS asked for public comments[13] on possible regulatory changes to strengthen the agency’s ability to “prevent, detect, and respond to fraud, waste, and abuse” in the Medicare, Medicaid, and the Children's Health Insurance Program (CHIP).[14] The scope of CMS’s request for public comment and recommendations is quite broad and covers the following topics:
- Modifications to Program Integrity Requirements.[15]
- Enhanced Identity Proofing and Ownership Requirements.[16]
- Preclusion List and Medicare Advantage Enrollment Requirements.[17]
- Reducing Medicare Fraud Related to Laboratory Tests, Including Genetic Tests and Molecular Diagnostic Tests.[18]
- Reducing Risks from Non-Participating Durable Medicare Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Suppliers in Medicare Advantage.[19]
- Reducing Fraudulent Medicare Parts A and B (Traditional Medicare) Claim Submissions.[20]
- Artificial Intelligence in Medicare Advantage Coding Oversight and Hospital Billing.[21]
- Beneficiary Solicitation.[22]
- Beneficiary Contact. [23]
- Surety Bonds. [24]
- Medicaid and CHIP. [25]
- State-Specific Medicaid and CHIP Questions.[26]
- Federally Facilitated Exchange (FFE) and State-Based Exchanges (SBEs) [27]
As this range of topics shows, CMS’s CRUSH Initiative is not limited to a specific geographic region or a narrow set of Medicare, Medicaid, or CHIP services. CMS is approaching the CRUSH Initiative as a system-wide effort to strengthen front-end controls across multiple federal health care benefit programs. Several of the issues discussed in the RFI are further discussed below.
A. Potential Expansion of Suspension Authorities.
Suspension actions are one of the primary program integrity enforcement tools used by CMS to stop the flow of Traditional Medicare payments to individuals and entities alleged to have received overpayments or engaged in fraudulent conduct.[28] A recurring theme throughout the RFI is whether certain anti-fraud mechanisms used in Traditional Medicare should be extended to Medicare Advantage and Part D plan sponsors. As an example, CMS asked whether it should establish regulatory authority to direct Medicare Advantage organizations and Part D plan sponsors to suspend payments to providers and suppliers under circumstances similar to those that exist in Traditional Medicare.[29] Should CMS proceed to implement these authorities, providers and suppliers should remember that there is no administrative appeals process available for them to challenge a suspension action. In the case of Traditional Medicare, the most a provider can do is submit a “rebuttal” letter to CMS outlining why the provider or supplier believes a suspension action is not warranted.[30]
B. Potential Increased Utilization of Automated Edits.
It is important to keep in mind that CMS has been at the forefront of predictive modeling and other analytic technologies for over a decade.[31] As mandated under Public Law 111-240, the “Small Business Jobs Act of 2010,” CMS developed and implemented the agency’s “Fraud Prevention System” (FPS) in 2011. As CMS notes:
The primary purpose of the FPS system in collecting PII is for fraud investigators to identify fraudulent claims before payments are made to providers. CMS direct contractors including Medicare Administrative Contractors (MAC), CMS Enterprise Data Centers (EDC), Recovery Audit Contractors (RAC), Unified Program Integrity Contractors (UPIC), and Common Working File (CWF) use the data, which includes PII, to investigate fraudulent claims.[32]
One of the defining features of the CRUSH Initiative is its emphasis on expanded, automated, data-driven efforts to stop improper Medicare fee-for-service payments before they are made. To the extent that this aspect of the CRUSH Initiative is ultimately implemented, Medicare providers and suppliers will likely see a significant increase in data-driven, automated claims denials. As error rates rise, we should also expect to see increases in payment suspensions and billing privilege revocations.
C. The Fraud Defense Operations Center.
In March 2025, CMS launched the Fraud Defense Operations Center (FDOC). The FDOC utilizes data analysts, investigators, health policy experts, legal personnel, and law enforcement partners to identify and disrupt suspect billing activity in real time. Although the FDOC has been operational for only a little over a year, the multi-agency team’s efforts have also resulted in the suspension of more than $1.8 billion in improper payments. [33]
D. Expanded AI-Driven Fraud Detection Capabilities.
One of the most significant aspects of the CRUSH Initiative is CMS's increased emphasis on AI-driven fraud detection tools that go beyond traditional automated claim edits in place for years. CMS has publicly stated that it is already using AI to combat fraud, waste, and abuse, detect anomalies in provider data, and improve operational efficiency across the agency. Moreover, CMS's own AI Playbook reflects that the agency is actively developing governance, deployment, risk mitigation, and human-centered oversight structures for AI initiatives used in agency operations.
As a practical matter, these efforts suggest that CMS and its contractors will continue using machine learning, predictive analytics, and related automated tools to identify billing anomalies, documentation inconsistencies, and suspect billing patterns more quickly than would be possible through manual review alone. Public reporting describing CMS's current fraud detection efforts indicates that these tools are being used to flag suspicious Medicare claims before payment, analyze large volumes of claims and provider data, and identify outlier billing patterns, geographic anomalies, and unusual coding combinations for further review.
For home health and hospice agencies, the practical takeaway is straightforward. Providers should expect that CMS and its contractors will continue comparing billing patterns against peer benchmarks, historical trends, and cross-program indicators when deciding whether additional scrutiny is warranted. As a result, providers whose claims appear facially compliant may nevertheless be subject to medical review, payment suspension, or other administrative action if their billing profile is flagged as aberrant by CMS's data-driven program integrity tools.
IV. CMS Program-Integrity Events Since Announcing the CRUSH Initiative:
The most concrete post-announcement event associated with the CRUSH Initiative is CMS’s imposition of a six-month nationwide enrollment freeze on home health and hospice services beginning May 13, 2026. On May 15, 2026, CMS published a Federal Register notice formally announcing a nationwide temporary moratorium on Medicare enrollment of home health agencies, effective May 13, 2026.[34] CMS contemporaneously announced that a six-month moratorium would also apply to hospices.[35]
CMS stated that any initial enrollment applications or change-in-majority-ownership applications submitted by home health and hospice agencies after the moratoria took effect would be denied. This is a significant development because it reflects the use of enrollment-based restrictions as a direct fraud-prevention strategy. Rather than merely auditing or revoking providers after claims activity occurs, CMS is restricting entry and ownership changes in categories it regards as especially vulnerable to abuse.
The home health moratorium also reflects the agency’s longstanding risk-based screening framework.[36] Since 2011, newly enrolling home health agencies have been categorized as “high risk” and assigned that level of pre-enrollment screening by CMS. This means that initial enrollment and certain ownership changes require heightened screening measures, including site visits and fingerprint-based criminal background checks for owners with a five percent or greater interest. In the May 2026 notice, CMS emphasized persistent program-integrity concerns in the home health sector and justified the moratorium on that basis.
This development is also notable for another reason. It shows that CMS’s CRUSH concerns are not confined to only DMEPOS suppliers. Although CMS’s February 2026 announcement prominently included a nationwide moratorium on new enrollment for certain DMEPOS suppliers, by May 2026, CMS had expanded the use of temporary enrollment moratoria to home health and hospice agencies.
V. Frequently Asked Questions – The CRUSH Initiative:
| Frequently Asked Questions – The CRUSH Initiative |
|---|
| #1. Question: How should a Medicare-enrolled provider or supplier prepare now, before CMS issues any final CRUSH-related rule?
#1. Response: Medicare-enrolled providers and suppliers should act now on the assumption that CMS will continue expanding data-driven, front-end program-integrity efforts. Moreover, we fully expect CMS to take the necessary steps to enhance its administrative enforcement authorities. These enhancements will likely include an expansion of the agency’s ability to suspend a provider’s payments, additional screening requirements at enrollment and reenrollment, and expanded revocations of billing privileges. Therefore, we believe that the prudent course would be for Medicare-enrolled providers and suppliers to:
The bottom line is that it would be a mistake to wait for a final CRUSH rule before reviewing your business practices and improving controls. CMS’s existing authorities already support substantial enforcement activity, and the RFI indicates those tools may soon become broader, faster, and more automated. |
| #2. Question: Can CMS stop us from enrolling a new practice location, adding a new entity, or completing a change in ownership?
#2. Response: If your business model depends on new Medicare enrollment, opening a new location, acquiring an existing provider through a change in majority ownership, or entering a provider segment that CMS views as high-risk, you should treat enrollment risk as a front-end enforcement issue, not merely an administrative filing issue. |
| #3. Question: Can we challenge CMS’s imposition of an enrollment moratorium on specific providers or suppliers?
#3. Response: No. There is no judicial review of a temporary moratorium “under section 1395ff, section 1395oo, or otherwise.” [37] In fact, CMS already has statutory and regulatory authority to impose a temporary enrollment moratorium when it determines one is necessary to prevent or combat fraud, waste, or abuse.[38] The implementing regulation[39] expressly allows CMS to impose a moratorium on new Medicare providers and suppliers of a particular type or on new practice locations of a particular type in a geographic area, for 6 months, with 6-month extensions if CMS deems them necessary. CMS may impose a moratorium where it determines there is a significant potential for fraud, waste, or abuse, including based on data trends, rapid application growth, or consultation with HHS-OIG and DOJ. |
| #4. Question: Should Medicare-enrolled providers and suppliers expect an increase in audits and an expansion of administrative sanctions?
#4. Response: Yes. Based on the questions raised in the RFI, it appears to be clear that CMS intends to continue and will likely expand prepayment reviews and postpayment audits of services and claims before payment has been made. As reflected in the RFI, CMS is seeking stakeholder feedback on how it can better use existing authorities and processes to deter fraud and promote payment accuracy. From a practical standpoint, Medicare-enrolled providers and suppliers should expect:
|
| #5. Question: Will Medicare Advantage and Part D plans be allowed to use stronger anti-fraud payment suspensions against providers?
#5. Response: Based on CMS’s concerns outlined in the RFI, we believe it is highly likely that CMS will authorize Medicare Advantage organizations and Part D sponsors to implement payment suspensions similar to those used in Traditional Medicare. Similarly, Medicare Advantage and Plan D sponsor organizations may also be delegated authorities to revoke a provider’s enrollment and deny a provider’s reenrollment in their respective plans. |
| #6. Question: Should Medicare-enrolled providers and suppliers expect a further tightening of enrollment, revalidation, and ownership disclosure requirements in the future?
#6. Response: The short answer is “yes.” The RFI expressly asks whether CMS should strengthen identity-proofing, expand screening to additional affiliated persons, and impose more stringent ownership-related requirements, especially for high-risk entities. We fully expect CMS to adopt more restrictive rules for enrollment, reenrollment, revalidation, and ownership disclosure. |
| #7. Question: Can CMS deny or place our claims on hold before payment based on automated screening?
#7. Response: Yes. CMS (primarily through its Medicare Administrative Contractors) has long used automated edits to identify and block improper payments before they are issued. CMS’s discussion of automatic pre-payment edits in the RFI is consistent with the agency’s previous efforts to move away from a historical “pay and chase” model and toward real-time prevention. Notably, CMS’s anti-fraud webpage reports that FY 2025 Medicare program integrity savings reached $41.9 billion, with a Medicare ROI of 22.3 to 1, which CMS attributes to intensified fraud-prevention activity.[40] HHS-OIG’s recent reports likewise continue to emphasize vulnerabilities related to improper payments and weaknesses in safeguards for services such as virtual check-ins, e-visits, and selected office-based procedures.[41] |
VI. Implications for Providers and Suppliers Participating in Medicare, Medicaid, and the CHIP Programs:
The February 2026 CRUSH RFI is truly remarkable in its scope because it is not limited to a discrete fraud issue, a single provider type, or even a single federal health care program. Instead, CMS has used the RFI to seek comments and feedback on a sweeping redesign of its program-integrity framework across Medicare, Medicaid, CHIP, Medicare Advantage, and Part D. We may soon see significant program integrity enhancements to existing provider enrollment requirements, billing privilege revocation authorities, payment suspension standards, medical reviews, data analytics, identity-proofing requirements, and ownership disclosures. Additionally, we should expect a new set of anti-fraud controls focusing on managed care claims. Read as a whole, the RFI signals that CMS is seriously considering a much more aggressive front-end enforcement model designed to stop suspect claims before they are paid and to block questionable actors before they can fully participate in federal health care programs. If even a portion of the proposals outlined in the RFI are ultimately adopted, the stakes for Medicare providers and suppliers will rise substantially. Providers should reasonably expect greater use of automated pre-payment claims edits and denials, more claims being routed to prepayment review, and a more frequent use of payment suspensions and revocations as CMS seeks to operationalize a “detect and deploy” anti-fraud strategy rather than relying on the traditional “pay and chase” model.
VII. Responding to a Prepayment or Postpayment Audit of Your Claims:
The program-integrity events that have occurred since CMS announced the CRUSH initiative confirm that the agency is moving aggressively toward a prevention-first model of health care fraud enforcement. The recent nationwide moratoria on Medicare enrollment for home health and hospice agencies are further evidence of the agency’s anti-fraud agenda.
Whether CMS ultimately adopts a formal CRUSH rule that expands these authorities remains to be seen. Even without such a rule, however, the initiative has already produced meaningful administrative consequences. For providers, suppliers, and their counsel, the practical lesson is straightforward: under CRUSH, program-integrity risk is increasingly being addressed at the front end, before payment and, in some cases, before enrollment itself.
In consideration of CMS’s renewed emphasis on prepayment audits and reviews, it is imperative that you review your current medical necessity, documentation, billing, and coding practices to ensure that you are fully complying with applicable coverage and payment guidelines. Home health, hospice, DMEPOS, and laboratory testing are likely to remain at the top of the list for audits and investigations throughout 2026. If your claims for Medicare or Medicaid services are audited, you need to have an experienced health lawyer in your corner. The attorneys at Liles Parker have extensive experience representing providers and suppliers in Medicare and Medicaid audits and investigations. Schedule a free initial consultation with Liles Parker.
Ashley Morgan is a Partner at the health law firm, Liles Parker. She is an experienced healthcare attorney and holds certifications as a Certified Professional Coder (CPC) and as a Certified Medical Reimbursement Specialist (CMRS). Her practice is concentrated exclusively on healthcare law, particularly on appeals of claim denials, regulatory guidance, and compliance planning. For a free initial consultation, click here.
- [1] Robert F. Kennedy was sworn in as the 26th Secretary of the U.S. Department of Health and Human Services (HHS) on February 13, 2025.
- [2] Dr. Mehmet Oz was sworn in as the Administrator of the Centers for Medicare and Medicaid Services (CMS) on April 18, 2025.
- [3] See generally 42 U.S.C. §1320a-7k(d).
- [4] “Medicare, Medicaid, and Children’s Health Insurance Programs: Announcement of Nationwide Temporary Moratoria on Enrollment of Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Supplier Medical Supply Companies.” 91 Fed. Reg. 9855 (February 27, 2026).
- [5] CMS Press Release, “Trump Administration Prioritizes Affordability by Announcing Major Crackdown on Health Care Fraud.” (February 25, 2026).
- [6] "Request for Information (RFI) Related to Comprehensive Regulations to Uncover Suspicious Healthcare (CRUSH).” 91 Fed. Reg. 9803 (February 27, 2026). As the issuance notes:
“This request for information (RFI) solicits stakeholder feedback on potential regulatory changes that might be included in a potential upcoming CRUSH proposed rule, as well as other programmatic changes that could be implemented to make CMS more effective in crushing fraud to protect taxpayer dollars and the Americans we serve.”
- [7] Presidential Memoranda, “Eliminating Waste, Fraud and Abuse in Medicaid.” (June 6, 2025).
- [8] Press Release, “DOJ-HHS False Claims Act Working Group.” (July 2, 2025).
- [9] Executive Order, “Establishing the Task Force to Eliminate Fraud.” (March 16, 2026). The Executive Order directed a national strategy on federal benefit fraud, including eligibility verification, pre-payment controls, data sharing, dismantling fraud networks, audits, compliance monitoring, and provider revalidation.
- [10] An infographic summarizing CMS’s administrative accomplishments for calendar year 2025 is available here.
- [11] 42 C.F.R. §405.371 - Suspension, offset, and recoupment of Medicare payments to providers and suppliers of services.
- [12] 42 C.F.R. §424.535 – Revocation of enrollment in the Medicare program.
- [13] The RFI’s formal comment deadline was March 30, 2026.
- [14] “Request for Information (RFI) Related to Comprehensive Regulations to Uncover Suspicious Healthcare (CRUSH).” 91 Fed. Reg. 9803 (February 27, 2026).
- [15] 91 Fed. Reg. 9803, 9804 (February 27, 2026).
- [16] 91 Fed. Reg. 9803, 9804 (February 27, 2026).
- [17] 91 Fed. Reg. 9803, 9805 (February 27, 2026).
- [18] 91 Fed. Reg. 9803, 9805 (February 27, 2026).
- [19] 91 Fed. Reg. 9803, 9805 (February 27, 2026).
- [20] 91 Fed. Reg. 9803, 9806 (February 27, 2026).
- [21] 91 Fed. Reg. 9803, 9806 (February 27, 2026).
- [22] 91 Fed. Reg. 9803, 9806 (February 27, 2026).
- [23] 91 Fed. Reg. 9803, 9806 (February 27, 2026).
- [24] 91 Fed. Reg. 9803, 9807 (February 27, 2026).
- [25] 91 Fed. Reg. 9803, 9807 (February 27, 2026).
- [26] 91 Fed. Reg. 9803, 9807 (February 27, 2026).
- [27] 91 Fed. Reg. 9803, 9808 (February 27, 2026).
- [28] 42 C.F.R. §405.371(a)-(c).
- [29] 91 Fed. Reg. 9803, 9804 (February 27, 2026).
- [30] For a detailed discussion of the Medicare suspension process, see our article titled “What is a Medicare Suspension of Payment Action?”
- [31] Pursuant to Public Law 111-240, “The Small Business Jobs Act of 2010,” the Secretary, Department of Health and Human Services, is required to use predictive modeling and other analytics technologies to identify improper claims for reimbursement and to prevent the payment of those claims under the Medicare fee-for-service program. See Page 124 STAT. 2599 (September 27, 2010). This led to CMS’s development and implementation of the agency’s “Fraud Prevention System” (FPS) in 2011.
- [32] At this time, CMS’s predictive modeling program is known as the Fraud Prevention System 2.0.” https://security.cms.gov/pia/fraud-prevention-system-20
- [33] See CMS’s “Fraud Defense Operations Center – Fast Facts.” (June 2025). https://www.cms.gov/files/document/cms-fraud-waste-and-abuse-sprint-strategy.pdf
- [34] “Medicare, Medicaid, and Children’s Health Insurance Programs: Announcement of Nationwide Temporary Moratoria on Enrollment of Home Health Agencies (HHAs).” 91 Fed. Reg. 27,954 (May 15, 2026).
- [35] “Medicare, Medicaid, and Children’s Health Insurance Programs: Announcement of Nationwide Temporary Moratorium on Enrollment of Hospices.” 91 Fed. Reg. 27,946 (May 15, 2026).
- [36] The current pre-enrollment screening procedures utilized by CMS arose out of the passage of the Affordable Care Act (ACA). the ACA furnished CMS with additional screening tools, such as fingerprinting and criminal background checks. Second, CMS was authorized to issue regulations that would classify providers based on their perceived risk for fraud and then link those classifications to a battery of pre-enrollment screening procedures. Providers that fall within a certain risk category are required to comply with all of the attendant screening standards. On February 2, 2011, CMS released a Final Rule addressing these provider risk classifications and screening methods. See “Medicare, Medicaid and Children’s Health Insurance Programs; Additional Screening Requirements, Application Fees, Temporary Enrollment Moratoria, Payment Suspensions and Compliance Plans for Providers and Suppliers.” 76 Fed. Reg. 5862 (February 2, 2011).
- [37] 42 U.S.C. § 1395cc(j)(7)(B).
- [38] 42 U.S.C. § 1395cc(j)(7)(A).
- [39] 42 C.F.R. § 424.570.
- [40] CMS’s webpage titled “Crushing Fraud, Waste, & Abuse.” https://www.cms.gov/fraud
- [41] HHS-OIG’s webpage titled “What’s New.” https://oig.hhs.gov/newsroom/whats-new/