Feds deploy AI against Medicare fraud

The Justice Department’s 2025 National Health Care Fraud Takedown charged 324 defendants tied to an alleged $14.6 billion in intended losses and seized more than $245 million in assets. (justice.gov)) DOJ and partner agencies have created a Health Care Fraud Data Fusion Center to combine cloud computing, AI and advanced analytics for faster identification of emerging schemes across jurisdictions. (meritalk.com)) CMS’s Feb. 25, 2026 “CRUSH” package includes a $259.5 million deferral of federal Medicaid funds to Minnesota and a nationwide six‑month moratorium on new enrollments for certain DMEPOS suppliers. (cms.gov)) The CRUSH Request for Information seeks stakeholder input on regulatory and AI-driven anti‑fraud approaches, with public comments solicited through March 30, 2026. (medicaleconomics.com)) Congressional testimony shows CMS reports revoking billing privileges for 5,586 providers and forwarding 372 fraud referrals covering roughly $3.7 billion in Medicare and Medicaid billing to law enforcement. (d1dth6e84htgma.cloudfront.net)) CMS published a Revoked Medicare Providers and Suppliers dataset on Data.CMS.gov (metadata updated March 3, 2026) to make revocations and re‑enrollment bars machine‑readable for payers and investigators. (data.cms.gov)) CMS’s Fraud Defense Operations Center pilot (March 31–May 1, 2025) was made permanent after the agency said it halted improper payments and reported roughly $105 million in pilot savings. (cms.gov)) CMS has acknowledged wider use of AI across program integrity efforts (CMS officials said AI helped save about $2 billion), while the agency’s Fraud Prevention System has been built and operated in partnership with federal contractors such as Peraton. (nextgov.com)) Medicare Advantage plans and Part D sponsors are required to deny payment for items or services from providers on CMS’s preclusion or revocation lists, creating a public signal that insurers and networks can use in contracting and SIU screening. (cms.gov))