CMS Medicaid Fraud War Room stops more than $203 million in improper payments

The Medicaid Fraud War Room (MFWR), a joint federal-state task force launched to identify high-risk providers, suspended more than $203 million in potentially improper Medicaid payments in just under 90 days, according to a Centers for Medicare and Medicaid Services (CMS) news release.

What the war room has found so far

Since its launch on April 23, the MFWR has coordinated enforcement actions against 50 unique, high-risk Medicaid providers identified through billing analytics, the release states.

Those actions can be separated into two categories: 42 federal notices of intent to exclude providers from federal health care programs, issued by the HHS Office of Inspector General and representing approximately $160.7 million in Medicaid payments since Jan. 1, 2025, and 15 state enforcement actions based on MFWR referrals, representing about $46.2 million. Seven providers were subject to both federal and state action, all of which, when combined, equal 50 unique providers and approximately $203.3 million in flagged payments.

An example of the type of case the MFWR has flagged is listed on a CMS fast facts sheet on the initiative: a laboratory testing provider that was billing repeatedly for a genetic test meant to be performed once. In 2025 alone, the provider received $4.5 million for repeat testing on 520 patients. A review of medical records found falsified records and a lack of medical necessity for the testing. According to CMS, the provider will be excluded from federal health care programs following the Office of Inspector General’s notice of intent, the state where it operated has stopped sending it payments and investigators are continuing to pursue financial recoveries.

How the task force operates

The MFWR was created in direct collaboration with the White House Task Force to Eliminate Fraud, led by Vice President JD Vance, according to CMS. The task force brings together CMS, the HHS Office of Inspector General, state Medicaid agencies and federal law enforcement partners to identify and address high-risk providers.

The Medicaid effort builds on CMS's Fraud Defense Operations Center, the agency's Medicare-side program that uses the same data-driven model. CMS says that program suspended more than $1.8 billion in suspected improper Medicare payments in 2025, its first full year of operation, including more than $1.5 billion tied to suspect durable medical equipment billing, $170 million for suspect skin-substitute billing and $100 million for suspect laboratory billing.

“Every dollar lost to Medicaid fraud is a dollar taken away from vulnerable Americans who rely on it,” CMS Administrator Mehmet Oz, M.D., said in the news release. “In just under 90 days, the Medicaid Fraud War Room has proved that these losses aren’t inevitable and has shown Americans what we can accomplish with robust federal-state partnerships, advanced data analytics, and a real sense of urgency. We’ve made significant progress toward crushing waste, fraud, and abuse, but we’re not done yet. If you steal from Medicaid, we will track you down, cut you off, and work to ensure that every taxpayer dollar we spend funds quality care for eligible beneficiaries.”

Why it matters for state Medicaid programs

The announcement is part of a broader CMS effort to expand Medicaid program integrity oversight in 2026, which has separately included a directive for states to revalidate high-risk providers. The figures CMS reported reflect notices of intent to exclude and state enforcement referrals — administrative actions that flag providers for further review — rather than final fraud convictions or civil judgments. A related HHS Office of Inspector General report found that many state contracts with Medicaid managed care organizations lack the specificity to ensure timely fraud referrals, a gap the MFWR is designed to close.