On June 24, 2026, the Joint Economic Committee held a hearing to examine ways to prevent health care fraud and instances where health care programs are not being used as intended. Chairman David Schweikert (R-AZ-1) encouraged Committee members and witnesses to focus on tangible solutions to the issue. Members discussed ways to reduce health sector consolidation, prevent fraudulent actions from health plan brokers, and leverage technology to reduce fraud in federal health programs.
OPENING STATEMENTS
WITNESS TESTIMONY
- Dr. Brian Blase, Founder and President, Paragon Health Institute – Testimony
- Dr. David Meyers, Associate Professor of Health Services, Policy, and Practice, Associate Director of the Center for Advancing Health Policy Through Research, Vice Department Chair, Brown University – Testimony
- Dr. Chris Pope, Senior Fellow, Manhattan Institute – Testimony
- Jessica Tillipman, J.D., Associate Dean for Governmental Procurement Law Studies, Government Contracts Advisory Council Distinguished Professorial Lecturer in Law, George Washington University Law School – Testimony
MEMBER DISCUSSION
Consolidation
Multiple members expressed concerns about the level of consolidation and vertical integration in the health system. Reps. Don Beyer (D-VA-8) and Victoria Spartz (R-IN-5) asked for solutions to prevent consolidation as well as to unwind some of the current consolidation. Dr. Meyers expressed that it would be extremely challenging to unwind current consolidation but gave recommendations to prevent further consolidation. These recommendations include structural separation, preventing health plans from acquiring more providers, and changing incentives, such as site neutral payment reforms, risk adjustment, and the medical loss ratio, to prevent encouraging more consolidation.
Brokers
Democrats on the Committee raised concerns about health insurance brokers. Ranking Member Maggie Hassan (D-NH) and Rep. Beyer wanted to understand how to prevent brokers from acting fraudulently. Dr. Meyers highlighted registering brokers, requiring stricter beneficiary understanding and consent for their plan of choice, and changing incentives for brokers to enroll a beneficiary in a specific plan by standardizing plan payments to brokers and making brokers a fiduciary of the beneficiary. Ms. Tillipman was supportive of reevaluating the specific incentives that create issues with brokers, but she cautioned the committee to not create broad disruptions.
Medicare and Medicaid
Chairman Schweikert suggested that a universal solution to fraud in Medicare Advantage would be to move to a capitated payment model, with a longer enrollment period. Dr. Meyers shared that a capitated model could be beneficial for improving plan incentives to support beneficiaries but cautioned that there would need to be a way for beneficiaries to leave the plan before their enrollment was over.
Rep. Spartz raised concerns about the high levels of automatic funding for federal health programs and questioned if Congress should provide more regular oversight. Dr. Blase agreed, sharing that the Medicare Part B trust fund will soon reach insolvency which will force Congress to address spending.
Sen. Amy Klobuchar (D-MN) asked each witness to share the top bipartisan reform Congress should focus on. Dr. Blase highlighted the need for the federal government to recoup funds states have spent on improper Medicaid payments. Dr. Pope shared that there needs to be increased documentation of services received by enrollees in Medicaid managed care plans.
Technology
Chairman Schweikert was curious if there was a universal data solution to reduce fraud. Dr. Blase shared that while artificial intelligence may play a role, he would recommend Congress focus on reducing the distortions that occur due to government payment policies. Dr. Meyer suggested that developing a better plan finder tool could be beneficial, as well as overlaying technology on top of other larger reforms to increase their impact. Sen. Klobuchar was interested in technological improvements but highlighted that many government computer systems need system wide upgrades to bring them into the modern age. Ms. Tillipman agreed, sharing that public systems need widespread upgrades to allow them to share information broadly, which can reduce duplicate work and decrease fraud.
