science
CMS Launches Medicaid Fraud Crackdown as Insurers Opt Out of Medicare Weight Loss Drug Pilot
The Centers for Medicare & Medicaid Services announced a nationwide effort to combat Medicaid fraud, requiring states to submit provider revalidation plans. Separately, health insurers declined to participate in a Medicare pilot program for discounted weight loss drugs, prompting the government to fund the initiative differently.
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This directive was announced at a health care summit, where the CMS administrator emphasized that states must address the issue regardless of political affiliation. Failure to comply could lead to more aggressive federal oversight.
The campaign includes sending formal requests to every state this week. In February, CMS temporarily withheld $259.5 million in payments as part of related efforts. The initiative follows a broader push against fraud, with the vice president leading the administration's efforts. CMS stated that non-compliant states would indicate a need for intensified audits.
“We’re asking the states to own that problem red and blue, all of them. If you don’t take it seriously, it indicates to us that we might have to take the audits more aggressively.”
Health insurers have declined to participate in a Medicare pilot program aimed at providing discounted weight loss drugs to seniors. The program, known as BALANCE, was intended to test whether covering obesity medications could save money or improve health outcomes without additional costs.
Last year, the administration negotiated a deal with Eli Lilly and Novo Nordisk to reduce prices of their obesity drugs to $245 per month in Medicare and Medicaid, with beneficiaries paying $50 monthly. Medicare is generally prohibited from covering weight loss drugs, but the pilot proposed waiving this restriction.
