Crushing Fraud, Waste, & Abuse

Crushing Fraud, Waste, & Abuse

CMS is crushing fraud, waste, and abuse to protect Americans.

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Notice:
Alert: Medicare Fraud Scheme Involving Phishing Requests Via Fax and Other Means

CMS has identified a fraud scheme targeting Medicare providers and suppliers. Scammers are impersonating CMS and sending phishing requests for medical records or payment of alleged Medicare debts, often via fax or email, falsely claiming to be part of a Medicare audit or debt collection efforts.

Important: CMS generally doesn’t initiate audits via fax or email unless a provider requests it, and Medicare overpayment collections are handled through an established process through the Medicare Administrative Contractors (MACs). Protect your information. If you receive a suspicious request, don’t respond. If you think you got a fraudulent or questionable request, work with your Medical Review Contractor to confirm if a medical records request is real or your MAC for overpayment collections.

CMS ACCOMPLISHMENTS 

JANUARY 1, 2025 - JUNE 30, 2025

OVERPAYMENT PREVENTION

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CMS imposed 223 Medicare payment suspensions on providers

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Over $1.3 billion in payments are on hold following payment suspension

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Through medical review activities, CMS fraud contractors identified $1.1 billion in overpayments across 1,539 Medicare providers

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Automated edits guarding against improper payments and potential fraud have denied payment for over 600,000 items or services, totaling over $106 million.

CMS revoked the ability of 3,152 providers and suppliers to bill the Medicare program due to inappropriate behavior.^

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INVESTIGATIONS AND REFERRALS

CMS Referrals Accepted by Law Enforcement

Referrals Law Enforcement bar chart. Medicare FFS is 121, Medicaid is 32, Medicare Parts C and D is 33.
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Law enforcement accepted 186 CMS fraud referrals for potential legal action

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These referrals encompassed $1.3 billion in billing

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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 130,000 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)

Fraud Defense Operations Center (FDOC)

Hospice Fraud

RADV Audits

Page Last Modified:
07/29/2025 12:03 PM