RFK Jr, Dr. Oz on Medicare, Medicaid fraud

[00:00:00]federal healthcare programs, and in many cases, can permanently ban them from returning.

[00:00:05]Unlike Medicare, the states control most of Medicaid's funding, and they provide the guardrails.

[00:00:14]We provide the funding, the states are responsible for how they spend it.

[00:00:19]And by law, they must document how they spend federal dollars.

[00:00:24]And we have reason to believe that taxpayer money is being misused, especially through fraud.

[00:00:31]We have a duty to stop the payments, demand answers, and then follow the evidence wherever it leads.

[00:00:38]If Governor Gavin Newsom or Governor Tim Walz wants this funding released, all they have to do is provide basic documentation showing that these services are legitimate and not fraudulent.

[00:00:51]And that's common sense. But the Biden administration abandoned that kind of oversight.

[00:00:57]Instead of protecting your money, they opened the floodgates to theft.

[00:01:02]They dismantled basic program integrity and oversight.

[00:01:06]When Xavier Becerra came into this office, there were 80 only 80 individuals involved in the program integrity program.

[00:01:15]At the time that I got in, there were only six.

[00:01:19]Uh 74 of those were gone. That's six individuals responsible for ensuring program integrity and guarding against fraud in 50 states and five territories.

[00:01:31]Even when they suspected fraud, the Biden HHS sent checks anyway and tried to claw back the money later.

[00:01:40]It didn't make sense, and it didn't work.

[00:01:43]The scammers got paid, taxpayers got stuck with these enormous bills.

[00:01:49]Under President Trump, HHS is restoring common sense.

[00:01:53]We are not sending Medicaid and Medicare dollars out the door until we have confidence that they're being spent lawfully and appropriately.

[00:02:02]CMS is working alongside the White House task force and our fearless leader J.D.

[00:02:08]Vance.

[00:02:09]Together, we've already identified and stopped 42 million dollars in Medicare fraud.

[00:02:16]That That's about That is more than the GDP of in the world.

[00:02:26]That's how much fraud, waste, and abuse the Trump administration has uncovered and stopped in just one federal agency.

[00:02:34]If left unchecked, that kind of fraud threatens these programs and the people who rely on them, the most vulnerable populations in our country.

[00:02:44]President Trump wants to protect Medicaid and Medicare, and we are doing that by remaining strong and guarding against the fraud, waste, and abuse that jeopardizes those programs and the Americans who rely on them.

[00:02:59]As FTC Chairman Andrew Ferguson, who helped lead the White House task force, put it, our benefit programs and our whole society were designed for high-trust people.

[00:03:10]The Biden administration nearly broke that high-trust society.

[00:03:14]They looked the other way while fraud, waste, and abuse exploded, and they incentivized fraud, waste, and abuse in all 50 states.

[00:03:23]They held no one accountable.

[00:03:25]They violated the social contract that makes this country strong and that makes our democracy function.

[00:03:32]To restore that trust, we have to enforce the law. We have to end the fraud, waste, and abuse, and this administration will do whatever it takes to keep your taxpayers dollars out of the hands of criminals and fraudsters.

[00:03:48]If your state wants Medicaid funding, it must meet basic documentation requirements.

[00:03:54]If police suspect fraud, you will not receive taxpayer dollars until you prove that those payments are legitimate.

[00:04:01]That's how we make America healthy again.

[00:04:04]That's how we restore the integrity of our democracy.

[00:04:07]And that's how we make America great again.

[00:04:10]And thank you. And now I want to introduce my friend and colleague, CMS Administrator Seema Verma.

[00:04:21]>> [applause] >> Uh as a physician, I'll tell you that you stand for long periods of time, you'll get varicose veins more likely.

[00:04:34]So, there are a few seats here for many of the back who are standing. Um I'm gratified by the large number of individuals that came.

[00:04:41]We do have seats if you wish to sit.

[00:04:43]Secretary Kennedy, thank you for allowing us to crush fraud. It's one of the OKRs that came out specifically later. Uh designed early in this administration to make sure that we would tackle uh these challenges. I also thank the secretary for delegating exclusion authority to CMS. We will use it judiciously, learning from March Bell and other allies who've already been afforded that ability, that delegation.

[00:05:05]I also want to thank the president the which we're speaking about today. The people behind me are that all of government approach. They use all levers of government to be able to make sure we protect those on Medicare and Medicaid programs. We're making massive headway as Secretary Kennedy outlined. We're protecting American taxpayers, American patients, and the outrage, the anger that America feels crosses party lines on this issue.

[00:05:32]It's very, very difficult for anyone to think it makes sense to throw money away, especially since we think there are foreign multinational organizations involved in some of this weaponized fraud. In coordination with the with HHS obviously, OIG, the DOJ, the White House, the Department of Justice, most importantly, in this case, the states.

[00:05:52]We have the ability to prevent $100 billion from going out the door. The number that Secretary Kennedy outlined that the CPI group has already stopped at $42 billion is a stunningly high number, but it shows the amount of success we've had.

[00:06:06]Let me introduce some people behind me.

[00:06:08]Louis Singsing, you heard his quote earlier, runs the White House Anti-Fraud Task Force. Scott Brady on that team, as well. Justin Leader Lewis White House Task Force agree also joining us and will speak later. Mark Bell from OIG, Dan Brillman, Rory Howe, Kim Brandt, Janine Ilugo, and Steve Furena are all parts of the CPI entity that has been so effective in cleaning up the mess that we inherited a year and a half ago.

[00:06:32]Today, we are calling on two states, because this is a partnership. We need states involved, but there are two states in particular today that we have concerns about, California and Minnesota. We want them to come alongside us, federal partners, to ensure that Medicaid dollars go to the services that are required by real people with real problems getting real care. All of us have to fit together. We have uncovered, unfortunately, already, in the last 18 months, billions of dollars have been stolen from the American people, taxpayers, and from patients who often have lost their health, their lives, in these scandals.

[00:07:04]And those have only been used those funds to pad the pockets of criminals.

[00:07:08]No mas. No more. It stops.

[00:07:10]Every quarter for years, CMS has asked states to show us the receipts for their expenditures. In this administration, we took it to another level. We asked them to focus on targeted high-risk services, services that are often provided by your family, often provided by unlicensed individuals in unsupervised settings, doing things that we couldn't tell if they were actually happening. Those services, because they're high risk, demand that we're more thoughtful, more uh insightful about how we audit them and decide that they're legitimate or not. These are the areas where the data tells us that there there fraud and waste, and uh likely to occur, they do occur, and we're identifying it with unfortunate ease in the system. When there are signature and significant outliers, to patterns that we've identified, anomalies that seem to happen again and again and again, federal law mandates, requires us to pause that funding so that the states fix the problems. That is the story behind today's announcements. In Minnesota and California, our reviews are going back to just over the last few years, turned up the same recurring theme again and again, every single quarter, claims in these same high-risk categories that the states have not yet been able to document fully and acceptably to the federal government.

[00:08:18]Claims that are unresolved, and flame claims that smell like fraud.

[00:08:25]And if it smells like fraud, we're not paying for it anymore. Today, we are deferring over $1 billion in federal Medicaid dollars, $1 billion to to Minnesota and California until they can substantiate their claims from this past quarter of audits. Here's the breakdown for each state. I want to give you the details. You may have questions on it later on, but I want you to have all the data in one spot. In Minnesota, we're talking about 14 high-risk programs, high-risk service categories, like personal care and home-based services. Again, often these are services that your family would typically have provided for you, that the federal government has started to fund, but unfortunately, it can be abused. Roughly $413 million in claims were under review this quarter. That was the total in Minnesota. Of that, $3 million, a little over that, is tied to specific documentation gaps. As an example of a documentation gap, is charging us for care you provided to a deceased person.

[00:09:19]We're not going to pay for healthcare for dead people. And over $3 million in Minnesota, you'll see the numbers in California in a second, um a billion for minute care, or rather Medicaid beneficiaries or providers who are deceased is a red flag to us that you're not doing your homework well. Another portion, over $42 million, dollars comes from claims tied to nearly five I rather 870 providers that we flagged through fraud detection analytics. We identify people as being of the of of a character that historically defrauded the government.

[00:09:51]We don't trust them and when we see bills from them, we scrutinize them more aggressively. However, the largest part of today's deferral comes from something that's new this quarter and that's something worth paying attention to.

[00:10:01]Minnesota all 50 states but Minnesota in particular was asked to audit all the people providing services in these high-risk areas. And Minnesota itself has enrolled roughly 3,000 providers.

[00:10:14]3,000 providers who historically could send bills willy-nilly and be fine. They themselves have disenrolled them for failed background checks, failed site visits and other issues. This raises questions about the claims tied to these same providers in the quarter before they were removed. Again, Minnesota removed the providers, we look back to see how much they billed us last quarter and unfortunately, it was a lot. It's a big part, it's the majority of the 199 million dollars that we are deferring for Minnesota today. Now, let's go to California. This is the focus in California, it's called in-home supportive services, IHHS. Again, going to someone's home, providing them care that often times their families would have offered. This provides care for seniors and for people with disabilities so they can remain safely in their own homes. Done correctly, these programs could make sense. Over the past two federal fiscal years, California's spending in this program, this is a critical statistic. Comparing state to state, California's spending in these in-home programs went up 24%.

[00:11:16]The rest of the country's average is about 12%. So, California increased spending at twice the rate of the average of the rest of the entire nation. That doesn't make sense. That gap accounts for about 391 million dollars of today's deferral. Another 250 million quarter billion dollars comes from claims tied to high-risk providers, as I explained earlier. Those who are billing more than a year after the service is provided, those billing for four or more patients all at the same time. Hard to juggle that many patients.

[00:11:45]Although, and if they rank in the top 2 and 1/2% of all billers, we were worried about them. This is a very conservative approach, by the way. We could have taken a lot more money. But, this we believe is a very thoughtful, judicious way of moving forward. The final comes to about $5 million, by the way, when you also add uh some of the other red flag issues. And in particular, the the $5 million covers bills that were paid after a beneficiary's date of death.

[00:12:08]It's a bad look, again, when you're billing the federal government for dead people's health care. Uh would not as needed after they pass.

[00:12:14]Uh or during a hospital stay, when they weren't possibly at home to get the care you're claiming you gave them. Or if they're outside the eligibility barriers. This total audit adds up to $646 million, directly tied to our review of the in-home services. But, there's another big part here, that California has still not rectified. As part of our standard quarterly oversight, including a focused review of claims involving individuals with unsatisfactory immigration status.

[00:12:41]Unsatisfactory immigration status means you can't prove that they're supposed to be in America, and that they're eligible for these services. Because this is a ongoing massive problem for California, we're also deferring an additional $221 million uh this quarter. Dan Brillman will speak more specifically about these. But, all together, $867 million dollars deferred from California today. Added together, it's over a billion dollars. California, Minnesota, the states and CMS have a stake in getting this right, protecting our most vulnerable. That's why it's a whole-of-government approach. It takes vigilance on both sides. We are committed to supporting this program, to cleaning up the fraud in health care. We need states to be true partners.

[00:13:21]Coming up and working with us to fix these problems, to protect the American people. Someone speaks to this more powerfully than anyone I know, Dan Brillman, who built a very large business outside of government, gave it all up to come into government, is in charge of CMS, which is Medicaid and chip and other services, and he's done a lot of the heavy lifting to work through this deferral process together with Rory and Steven who are standing over here to my left, Dan Brillman.

[00:13:49]>> Thank you, Dr. Ross, Secretary Kennedy.

[00:13:51]Let me start with something that's incredibly important. First, everything we do begins with data.

[00:13:57]This is data-driven analysis. These are anomalies, these are outliers, these are red flags that go way beyond the norm.

[00:14:03]Dr. Ross just talked about a few of them. And the team behind me at CMS works so hard that every dollar is spent correctly. Second, today's action doesn't change benefits or eligibility.

[00:14:14]This is a deferral. It's a pause to review past receipts. When we identify something that's inconsistent with how Medicaid operates, we ask questions. We want to make sure every dollar is spent correctly. And a deferral is exactly that. It's a pause to give the state the opportunity to demonstrate that every federal dollar claimed goes to what it's supposed to go to. So, what does the state need to do to make sure they recover this? First, as Secretary talked about, they need to produce complete documentation supporting the claims that were submitted. Second, they need to validate that the beneficiaries were eligible, that providers were qualified to bill for Medicaid, services were actually delivered, claims complied with federal and state requirements.

[00:14:51]And third, most importantly, this team behind here of experts from the task force as well, when states identify problems, they need to take action. They need to go after improper payments, they need to terminate and suspend providers, they need to strengthen program integrity controls, and they need to refer suspected criminal conduct to law enforcement.

[00:15:10]Now, if the documentation supports the claims, federal funds move forward. If it does not, taxpayers should not be paying for these services or these claims. And this is exactly how the stewardship of taxpayer dollars is supposed to work.

[00:15:23]Our objective is to make sure that every Medicaid dollar reaches those who need it.

[00:15:29]Here's why this matters. I just want to take a step back. Every governor, every legislator in the states, every Medicaid director faces choices.

[00:15:37]Every dollar lost to fraud is a dollar that cannot pay for a child with complex medical needs, an adult with intellectual disabilities, or a veteran like that I served with are waiting to receive services at home.

[00:15:49]So, let me make it real for you. Right now, there are hundreds of thousands of Medicaid beneficiaries waiting on what we call home and community-based services waitlist.

[00:15:59]These are people with intellectual developmental disabilities, medically fragile children, people with physical disabilities, including veterans I served with in the Air Force that rely on Medicaid now, waiting months or years on waitlists.

[00:16:13]If states can clean this up, reinvest those dollars, we can reduce or even eliminate these waitlists immediately, entirely clear them.

[00:16:22]Every person could get services so much faster. That's why we care so much about this.

[00:16:28]As someone who serves and continues to serve in the Air Force, this is personal to me and personal to a lot of people behind me that you're going to hear from.

[00:16:34]I served alongside men and women who rely on Medicaid today. They deserve to know that every dollar that we spend goes towards them and not fraudsters, waste, and abuse. I'll turn it over to our esteemed colleague Andrew Ferguson now.

[00:16:47]Thank you.

[00:16:51]>> [applause] >> Thanks, Stan.

[00:16:55]>> [clears throat] >> Vice I'm from the President's Task Force on Fraud. The Vice President, when the President put him in charge, articulated a two-pronged approach to fighting fraud in the federal government. The first, as Secretary Kennedy and Dr. Oz discussed, is we have to switch from the process of letting money flood out the door from the federal government into the world and then chasing it and hope we can get some of it back. It doesn't work. It's not how you have fight fraud. The way you stop fraud is you prevent the money from walking out the door. We've heard a lot about what CMS has done just in the last couple weeks to make sure that every single dollar is accounted for, that the money that the American people have turned over to the federal government that they earned their money, that they turned over to the federal government in an act of generosity to help their federal fellow citizens is actually going to help help their fellow citizens. The second prong that we talk about is making sure that people who commit fraud go to jail. Just last week or just a couple weeks ago on that front, the Department of Justice announced the arrest or indictment of more than 400 fraudsters who had committed more than $5 billion in Medicaid and Medicare fraud against the people of the United States. The results on the enforcement front have been massive. Just 2 months ago, Secretary or Director Cash Patel at the FBI, at the instruction of the Vice President, created the top 10 fraudsters most wanted list. And just since its creation, we have extradited three of the top 10 from foreign countries, from Turkey, from Somalia, from the Philippines. Just put that in context.

[00:18:31]Four years ago, the FBI under the previous administration was arresting grandmothers for praying rosaries outside of abortion clinics. And today, the FBI is chasing fraudsters who have built billions of dollars from American citizens to every corner of the world and bringing them back here to face justice at the hands of the people that they have hurt. So, on the enforcement front, the work of the of the acting Attorney General Todd Blanched, soon to be Attorney General Todd Blanched, has been phenomenal and it will continue.

[00:19:01]We've heard a lot about what we've done on the anti-fraud front by keeping money here at the HHS. I just want to talk about some of the work that the other agencies have been doing simultaneously.

[00:19:10]Department of Education, not a place you would probably think a lot of fraud is happening. Billions of dollars of loans are paid out to fraudsters who sign up for loans and for college degrees just to get the money and run. Just since the task force was formed, they've blocked more than a quarter billion dollars from walking out the door and estimate that their anti-fraud efforts that Secretary McMahon picked up from nothing. There was no anti-fraud work being done at the Education Department under the Biden administration and just since the Secretary McMahon's tenure, they're estimated to save more than two billion efforts this year alone. At HUD, the Secretary Turner, again, picking up an agency that had no meaningful anti-fraud work going, stopped money from going to the Los Angeles Housing Authority, which was being used not to fund work on uh homelessness in California, but was being used to fund left-wing NGOs. They are now cut off from receiving any more federal funds and just yesterday, HUD announced that the Virgin Islands Housing Authority, which has received hundreds of millions of dollars to rebuild the islands after hurricanes and was not using that money to rebuild the islands after hurricanes, has also been suspended from receiving federal grant funds on the same ground that the money is not being used for the purposes that American citizens are turning it over to these governments to use. Similarly, at the Small Business Administration, Secretary Leffler's team has identified more than 123 billion dollars in fraudulent SBA loans just this year alone and is on track to stop nearly a billion and a half and claw it back in this year. In the Department of Labor, our unemployment insurance program is critically important for Americans who are experiencing hard times, has uncovered 5.3 billion dollars in fraud and uh thanks to the work of Acting Secretary Sunderling and Inspector General DeSpirito, is working hard every day to recover those funds and get them back into the hands of the American taxpayers from whom they were taken.

[00:21:08]We've heard a lot about big numbers today, and they're really important, but I want to pick up on something that Mr. Brillman just talked about, which is more important than just the numbers.

[00:21:18]This fraud doesn't just hurt all taxpayers. It does.

[00:21:22]CMS alone pays out $2 trillion of money that American citizens turn over to HHS to help their families and friends and neighbors in need. That's more than the GDP of almost every other country on the planet that HHS pays out every year alone.

[00:21:38]But this isn't just about money taken from our pockets. This money, like Mr. Brillman was explaining, that should be going to people who actually need it, go to enrich the worst people in our society. When we were in Minnesota just a couple months ago, we were explaining to the press that an anti-homelessness program in Minnesota that was designed to protect many veterans from homelessness was shut down because it was so inundated with fraud, Minnesota couldn't even afford to keep it going.

[00:22:07]And we're going to hear later this afternoon or this morning about skin substitutes. We talked about those a couple weeks ago. But these aren't just This isn't just money that HHS was paying out to fraudsters. These were procedures being performed on people, surgeries being performed on people who didn't need it so that doctors could pocket the money.

[00:22:26]Stopping the fraud doesn't just protect the fisc. It protects real people from real injury, and it makes sure that American citizens who are entitled to this money, that all of us have given our money up to help, actually get the money. And the second issue that Secretary Kennedy just talked about that is so important for this anti-fraud effort is restoring social trust.

[00:22:51]All of these benefit programs are not designed to make sure, naturally, that every single dollar is going where it intend. When these programs were set up, they were set up on the assumption that everyone who participates in these programs, federal bureaucrats, state bureaucrats, and people who are going to apply for the programs, are going to play by the rules and that we can trust everyone to do it. And what we have learned is that that's just not true.

[00:23:15]Our society has disintegrated from the high trust society that it has been and the only way that we can restore that high trust is to make sure that the money stays in the agencies or goes to people who actually need it and if you get money fraudulently, you go to jail.

[00:23:31]And that is what this is this this anti-fraud effort is about. Not just protecting the fisc, it is restoring in America. It is making America great by making sure that the social trust that a self-governing needs to survive can be restored. That is why this effort is so important. And to talk a little bit more about the specifics, I'm going to turn it over to my friend Jetson Leder-Luis. He's the chief economist for the task force. So many of the great things that the agencies have been able to accomplish, they accomplish by working with Jetson, who's one of the country's leading academic experts on government fraud.

[00:24:07]Jetson.

[00:24:10]>> [applause] >> Thank you, Chairman Ferguson. Uh I appreciate that. My name is Jetson Leder-Luis and I'm the uh chief economist and deputy executive director of the White House Anti-Fraud Task Force. Uh I just want to give a shout-out and big thanks to Vice President Vance, uh without whom uh we could not be doing any of the things today.

[00:24:29]When fraudsters steal from federal programs, they are stealing from the American families that need those benefits to survive and I take that personally. When I was a young child, my family was homeless. I lived in a homeless shelter with my sister and my mom and we received food stamps to keep going.

[00:24:47]Eventually, my mom was able to find work and move us back into an apartment.

[00:24:51]And when later in life she got sick, she received Medicaid benefits that were we're to keep her in her home and out of a nursing home.

[00:24:58]And that's what these programs are designed for.

[00:25:00]These federal benefit programs are for the American families who need on hard times like my family and not to line the pockets of criminals.

[00:25:10]Um and so I'm thrilled to announce uh some great success on this front as well. Back in April, we launched a uh new approach to Medicaid fraud called the Medicaid fraud war room. And this is a combination of effort from CMS, from HHS OIG, from the states, and from the task force. Um and I'm uh glad to say that in the first 90 days of the Medicaid fraud war room, we have uh prevented uh we've surpassed over $200 million in prevention. Um that's real savings for the Medicaid program. And we're doing this using machine learning. That's a form of AI that allows us to analyze the Medicaid claims and then turn off the tap and stop providers from receiving fraudulent funds.

[00:25:54]Uh this is uh in contrast, as Secretary Kennedy talked about, to the old model of pay and chase. We are stopping the money before it ever goes out the door.

[00:26:02]And importantly, this is a scalable way of fighting fraud. We can do this in every federal program. We are doing this in every federal program. And uh I'm proud to say that we are currently tackling dozens of new Medicaid fraud cases per week using data.

[00:26:15]Um and that's ultimately what our task force is about. Our task force is about taking an all-of-government approach and leveraging the very best modern tools in order to protect the federal programs for families that need them. Um and so I'm thrilled to announce uh excuse me, to introduce uh my dear colleague Kim Brandt who will give even more details about Medicare fraud.

[00:26:39]>> [applause] >> Thank you, Jeff.

[00:26:41]Um what Dan mentioned earlier, a billion dollars in Medicaid dollars deferred because the documentation doesn't add up, is what happens when you catch fraud on the back end. It matters, but I want to tell you about what happens when you stop it on the front end because that is where CMS has been focused and we are seeing huge results. Last year, CMS stopped 41.9 billion dollars in Medicare program Medicare programs stopping allowing us to bring back that money to the trust fund, which is a 59% increase over the previous year and the highest return on investment ever recorded at CMS. That's money that will help to extend the life of the trust fund to provide benefit fits for everyone. 68% of those savings came from cost avoidance, stopping payments before they went out the door, not chasing them afterwards. On the Medicaid side, we recorded 4.1 billion in savings last year. That's a 165% increase from the year before. And that momentum has carried into this year. In just the first quarter, CMS has revoked 1,413 providers and suppliers. That's a 40% surge from previous years and the largest quarterly increase on record.

[00:27:53]We've imposed over 187 million dollars in payment suspensions just in the first quarter.