Insights

On March 17, 2026, the House Energy and Commerce Oversight and Investigations Subcommittee held a hearing on the role of the Centers for Medicare & Medicaid Services (CMS) in combating Medicare and Medicaid fraud. While both Democrats and Republicans agreed that fraud is hurting the program and its beneficiaries and should be stopped, they disagreed on the current practices CMS is using to assess state programs and identify fraud.

OPENING STATEMENTS

• Subcommittee Chairman John Joyce (R-PA-13)

• Subcommittee Ranking Member Yvette Clarke (D-NY-9)

• Full Committee Chairman Brett Guthrie (R-KY-2)

• Full Committee Ranking Member Frank Pallone (D-NJ-6)

WITNESS TESTIMONY

• Kim Brandt, Deputy Administrator and Chief Operating Officer, Centers for Medicare and Medicaid Services – Testimony

MEMBER DISCUSSION

Current Tactics Used to Find and Prevent Fraud

There was bipartisan questioning regarding the tactics CMS is currently using to identify and combat fraud. Full Committee Chair Brett Guthrie (R-KY-2) asked about the Fraud Defense Operation Center being referred to as the Fraud War Room. Ms. Brandt described this center as staffed by a mix of medical professionals and law enforcement, and she emphasized its data-driven approach to comparing Medicare and Medicaid spending with the state’s population enrolled in the programs. Rep. Diana Harshbarger (R-TN-1) asked Ms. Brandt about the most common types of fraud. Ms. Brandt listed fraud related to skin substitutes, genetic testing, hospice, home health, and durable medical equipment as being at the top of the list.

Vice Chairman Troy Balderson (R-OH-12) asked whether the provider verification and cross-check methods have been an effective tool. Ms. Brandt described them as very effective, specifically for on-site visits, background checks, fingerprinting, and data matching against the Social Security Death Masterfile. Rep. Lizzie Fletcher (D-TX-7) expressed concerns about the sharing of this data, to which Ms. Brandt explained CMS’s view that shared data can help identify types of fraud, but it must be protected.

Minnesota Investigation

Democrats used the Minnesota investigation as a cornerstone throughout their questioning. Subcommittee Ranking Member Yvette Clarke (D-NY-9) and Full Committee Ranking Member Frank Pallone (D-NJ-6) asked for more details on the steps taken as CMS has worked with Minnesota. Ms. Brandt explained that a team of experts from the Center for Program Integrity at CMS evaluated the corrective action plan submitted by Minnesota, and she personally communicated the feedback to them. Ranking Member Pallone then questioned the decision to withhold funds, given CMS historically withholds funds only when a state refuses to cooperate, which he argued Minnesota has done. Ms. Brandt said CMS only said it could withhold funds and that no action would be taken until the agency thoroughly reviewed the corrective action plan. She further explained that they determined Minnesota had adequate funds to sustain programming and said they would share the analysis with the subcommittee.

California Investigation

Another major topic for members of both parties was CMS’s investigation into alleged Medicare home health care and hospice fraud in California. Subcommittee Chair John Joyce (R-PA-13) and Rep. Kevin Mullin (D-CA-15) asked about these investigations. Ms. Brandt explained that she and Dr. Oz were recently in California and are planning to visit several states to conduct site visits to evaluate the condition of care centers and ensure that valid and legitimate services are being provided.

Future of Fraud Prevention in CMS

Republicans spent more time on the future of CMS’s anti-fraud efforts. Rep. Rick Allen (R-GA-12) and Rep. Harshbarger (R-TN-1) asked where Ms. Brandt sees current practices progressing. She explained they are working to create a 50 State Medicaid Program Integrity Playbook with the best practices so states can learn from one another. She further explained that they are working towards a “Stop and Cop” system, rather than a “Pay and Chase” system, to prevent money from being lost to fraud rather than attempting to recover it.

Other Topics

• Rep. Randy Weber (R-TX-14) asked how CMS is working to educate the elderly about suspected fraudulent activity. Ms. Brandt explained that Dr. Oz is making videos encouraging beneficiaries to call HHS and CMS if they suspect fraud, and that they are working with state officials to improve patrols.

• Rep. Lori Trahan (D-MA-3) and Rep. Kim Schrier (D-WA-8) questioned the removal of the independent Inspector General and President Trump’s pardoning of a number of people who have been convicted of fraudulently using Medicare and Medicaid services.

• Rep. Paul Tonko (D-NY-20) raised concerns about Vice President Vance’s involvement in antifraud efforts as he was designated by President Trump to be the anti-fraud lead.

• Rep. Buddy Carter (R-GA-1) voiced apprehensions regarding skin substitute fraud and the possibility of adverse effects for those needing care. Ms. Brandt stated they have not seen any adverse effects yet.

On March 2, 2026, the Medicare Payment Advisory Commission (MedPAC) held the first day of its March meeting. The Commissioners held two sessions on the Medicare Advantage (MA) program, where they discussed the impacts of provider networks for beneficiaries as well as possible risk-adjustment policies. While the Commission is not planning to publish the work presented in these sessions in future reports to Congress, it was noted that the conversations would help guide future work by the Commission.

PROVIDER PARTICIPATION IN MA NETWORKS

MedPAC staff began the session by offering a comprehensive overview of MA networks and the beneficiary experience. Staff noted that provider participation in specific networks can change mid-year, which can greatly impact the beneficiary experience. Through 2023 claims and encounter data, MedPAC staff found that most clinicians participated in at least 1 MA network, with 75% of providers participating in 3 or more networks. Staff highlighted how mid-year provider network changes can be disruptive for enrollees as beneficiaries need to find new providers. MedPAC staff found that from February 2023 to June 2023, MA networks experienced a net increase in providers, with a 3% increase in primary care providers (PCPs) and a 1% increase in specialists. However, providers still left networks, with 6% of PCPs and 4% of specialists exiting by mid-year.

Commissioners were most interested in understanding the level of access beneficiaries have to providers, noting that provider participation in a network does not directly translate into beneficiaries having access in a reasonable amount of time. Some suggestions for ways to better measure access included understanding the types of care beneficiaries receive out of network, analyzing Consumer Assessment of Healthcare Providers and Systems (CAHPS) scores for correlation rates, and offering structured interviews with beneficiaries, providers, and hospitals.

A few Commissioners suggested that future work could examine reasons why providers left a network, with one Commissioner pointing out that a large decrease in provider availability in a single network may be due to a larger system deciding not to renew a contract. One Commissioner who works in the space shared that, in his opinion, there are significant differences between data from 2023 and data from 2026 due to changes that reward clinical performance. The Commissioner explained that many MA plans are taking actions to steer beneficiaries towards high-performing but lower-cost care options, and removing higher-cost providers, which may have an impact on network robustness.

The Chair wrapped up the session by sharing that overall, the core value of the health system is being able to see a provider when care is needed, and conversations about MA provider networks can be difficult due to data completeness issues.

CONSIDERATIONS FOR IMPLEMENTING MA ENCOUNTER DATA IN RISK ADJUSTMENT

The MedPAC staff member provided an overview of how risk adjustment affects payments to MA plans and policy decisions that would need to be made in order to calibrate a risk adjustment system. There were 3 options presented. Under the first option, MA and Fee-For-Service (FFS) scores would be calculated from an MA-based risk model. Under the second option, MA and FFS risk scores would be calculated from separate MA-based and FFS-based risk models. Under the third option MA spending-based benchmarks would be calculated from existing MA data sources. Each option had different impacts on coding intensity and favorable selection, as well as partially or fully delinking MA payments from FFS data.

The Commissioners were very receptive to the presentation. No Commissioners expressed support for the first option, while options 2 and 3 were both of interest for future consideration. There was a desire from many Commissioners to create an external anchor for calculating payments, with a fear that if there is not an external source, it could be very easy for payments to increase drastically.

Commissioners had a few other considerations for a possible model, including clearly defining what constitutes an encounter, understanding the effects of different coding intensities, and separating benchmark and risk-adjustment policies. Commissioners shared the sentiment that moving towards a risk-adjustment model would improve plan data collection and reporting, which could be beneficial for other analyses.

Overall, the Commissioners were supportive of the options presented but wanted more pressure testing to better understand the possible implications for beneficiaries before a recommendation could be discussed.

On February 24, 2026, the House Ways & Means Health Subcommittee held a hearing on how to advance the next generation of the health care workforce. The discussion focused on expanding rural residency programs, rural workforce recruitment strategies, the use of foreign-trained physicians vs. developing a domestic health care workforce, and more.

OPENING STATEMENTS

• Rep. Adrian Smith (R-NE-3)
• Rep. Mike Thompson (D-CA-4)

WITNESSES

• Dr. Emily Hawes, Professor at UNC and Director, Sheps Graduate Medical Education Technical Assistance Center, Chapel Hill, NC – Testimony
• Mr. Jason Shenefield, CEO, Phelps Health – Testimony
• Dr. Thomas Mohr, D.O., Dean of Sam Houston State University College of Osteopathic Medicine – Testimony
• Dr. Jennifer Trilk, Ph.D., Director, Lifestyle Medicine, University of South Carolina School of Medicine, Greenville, Co-founder and Director of Lifestyle Medicine Education Curriculum – Testimony
• Dr. Andrew Racine, President, American Academy of Pediatrics – Testimony

MEMBER DISCUSSION

Rural Residency Programs

Rep. Adrian Smith (R-NE-3) asked Dr. Hawes to explain the process for establishing a rural residency program, especially for funding. Dr. Hawes shared that the biggest barrier is the initial start-up costs, and the Rural Residency Planning and Development (RRPD) Program is crucial for providing financial and technical assistance to help programs grow. Full Committee Chairman Jason Smith (R-MO-8) continued this line of questioning, asking how the funds are used. Mr. Shenfield shared that for his hospital, the funding can help with the administrative costs of the program and with creating clinical space for the residents to practice.

Rep. Carol Miller (R-WV-1) highlighted H.R. 6468, the Rural Residency Planning and Development Act of 2025, which would authorize rural residency planning and development programs. She also asked what other policy changes could be impactful for rural residency programs. Dr. Hawes answered that policies supporting telemedicine are greatly impactful, especially for psychiatric residency programs.

Rep. Brian Fitzpatrick (R-PA-1) asked how H.R. 3890, the Resident Physician Shortage Reduction Act of 2025, may be beneficial. Dr. Mohr explained that the legislation would provide greater clarity and certainty to hospitals looking to establish new rural residency programs.

Rep. Aaron Bean (R-FL-4) wanted the panel’s opinions on the possibility of shuffling the locations of residency spots every 10 years. Mr. Mohr shared that, in his view, there is a need to redistribute spots, but Dr. Hawes and Mr. Shenfield were concerned about the infrastructure required to support residency programs and the possible unintended consequences of the redistribution.

Rural Workforce Recruitment

Rep. Smith asked about challenges in recruiting physicians to rural health facilities. Mr. Shenfield stated that the need for physicians is greater in rural areas, but that there are fewer opportunities in rural communities, making it much harder to recruit physicians after they have completed their residency. Full Committee Chairman Smith asked how to improve the issue of medical students training in rural areas and then completing residency or practicing in urban areas. Dr. Mohr stated that solutions could include revisiting the graduate medical education (GME) caps, increasing training programs in rural areas, and updating medical education to promote rural practice. Dr. Hawes shared that residents often stay in the local community, so increasing rural residency spots is crucial.

Rep. Gregory Murphy (R-NC-3) highlighted that many rural communities are decreasing due to the lack of both healthcare and general infrastructure. Dr. Mohr agreed and stated that additional incentives are needed to attract residents to rural areas, and that improving infrastructure and opportunities in these communities could be helpful.

Rep. Miller requested that Dr. Mohr explain the role that Doctors of Osteopathic Medicine (DOs) can play in improving the rural workforce. Dr. Mohr shared that DOs are more likely to practice in rural and primary care settings, making them essential for meeting physician needs. Dr. Mohr highlighted the need for equity in licensing exams and residency spots for DOs.

Foreign Workforce

Rep. Linda Sanchez (D-CA-38) raised concerns that rural hospitals cannot afford the newly imposed H-1B visa fees, which would impact their workforce. Dr. Hawes agreed that the fees could have a negative impact. Dr. Racine argued that the fees would reduce the supply of doctors in rural areas, thereby affecting access to care.

Rep. Steube (R-FL-17) posed a variety of questions to the panel regarding supporting the foreign vs. domestic health care workforce. The panel expressed support for issuing visas to foreign-trained physicians but also agreed that there needs to be greater focus on training the domestic workforce. When asked by Rep. Steube what would help rural hospitals reduce the need for foreign-trained physicians, Mr. Shenfield said that the only answer was time to train the domestic workforce.