CMS aims to quadruple provider suspensions in six months, official says

CMS plans to quadruple provider suspensions over the next six months after receiving new exclusion authority from HHS. The agency is also piloting AI to detect Medicaid fraud and will publish results of an Indiana pilot with Oracle.

• New authority lets CMS exclude providers from Medicare, Medicaid and TRICARE
• Savings reached $41.9 billion in fiscal 2025, up 59% year over year
• Indiana Oracle pilot flags fraud before Medicaid payments are made
• The AI prior-authorization WISeR program drew criticism over care denials