Crushing Fraud, Waste, & Abuse
CMS is crushing fraud, waste, and abuse to protect Americans.
Announcement: CMS IDea Challenge: Strategies for Securing Member IDs
CMS is hosting two in-person events to combat fraud involving health plan identifiers (IDs) and enhance the security of those IDs. These collaborative events will bring together experts from diverse backgrounds to develop innovative ways to protect patient information. Learn more about the IDea Challenge here.
Announcement: Crushing Fraud Chili Cook-Off Competition
Phase 1 of the Crushing Fraud Chili Cook-Off Competition has concluded. On October 20, 2025, all participants who submitted entries for Phase 1 were notified via email regarding their selection status for Phase 2.
For selected finalists, Phase 2 will begin on October 30, 2025. See here for further information about the challenge.
CMS ACCOMPLISHMENTS
JANUARY 1, 2025 -AUGUST 31, 2025
OVERPAYMENT PREVENTION
CMS imposed 315 Medicare payment suspensions on providers
Over $1.8 billion in payments are on hold following payment suspension
Through medical review activities, CMS fraud contractors identified $1.6 billion in overpayments across 2,241 Medicare providers
Automated edits guarding against improper payments and potential fraud have denied payment for over 800,000 items or services, totaling over $141 million.
CMS revoked the ability of 4,242 providers and suppliers to bill the Medicare program due to inappropriate behavior.^
CMS denied 77,152 Medicare claims for unnecessary items and services because they failed to satisfy Medicare's preliminary approval checks that confirm medical necessity and other coverage requirements.
CMS has collected over $250 million in overpayments
through post-payment reviews.
INVESTIGATIONS AND REFERRALS
CMS Referrals Accepted by Law Enforcement
Law enforcement accepted 213 CMS fraud referrals for potential legal action
These referrals encompassed $2.6 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 180,000 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)
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Page Last Modified:
10/22/2025 03:45 PM