Presidential Administration and Congress Uniquely Focused on Program Integrity in Federal Programs

April 3, 2026

As the current Administration intensifies its focus on fraud, waste, and abuse (FWA), Medicare and Medicaid providers face growing financial pressure.

Program integrity has always been a part of Medicare and Medicaid, and the government has many tools to fight FWA at the state and federal levels. In 2025, CMS suspended $5.7 billion in suspected fraudulent Medicare payments and denied 122,658 Medicare claims for failing to meet medical necessity and other coverage requirements. In February 2026, the Centers for Medicare and Medicaid Services (CMS) launched the Comprehensive Regulations to Uncover Suspicious Healthcare (CRUSH) initiative as part of a strategy to combat FWA.

In January 2026, CMS notified Minnesota that pending the outcome of a hearing, it would begin withholding $515 million in quarterly federal Medicaid payments. State Medicaid programs are run on extremely tight budgets and rely on federal and state funds. Without federal funds, state Medicaid programs can struggle to pay providers like audiologists and SLPs-and have no backup plan when budgeted funds are unavailable.

Stopping payment doesn't just affect fraudulent providers; it affects all of them. This is playing out as part of new work requirements (or "community engagement") for Medicaid beneficiaries, which are set by the One Big Beautiful Bill Act. These requirements will make many states pay private corporations like Deloitte and Optum millions of dollars to track beneficiaries' work hours-and cause millions of people to lose health care coverage.

CMS issued a Request for Information (RFI) on February 27, soliciting feedback on potential regulatory changes that might be included in an upcoming CRUSH proposed rule. CMS also requested feedback on other program changes focused on combatting FWA in the Medicare and Medicaid Programs.

CMS solicited feedback from a range of stakeholders-including states, providers, suppliers, payers, technology companies, patient advocates, and beneficiaries-on a variety of areas that may impact audiologists and SLPs, including but not limited to:

• Suspension of Medicare and Medicaid payments to providers in the event of FWA;
• Mandatory provider enrollment in Medicare;
• Moratorium on New Durable Medicare Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) provider enrollment (which could include augmentative and alternative communication suppliers);
• Artificial intelligence usage in Medicare Advantage; and
• Risks of FWA in Federal Facilitated Exchange and state-based exchanges.

ASHA has submitted comments [PDF] to the RFI asking CMS to combat FWA using strategies that do not wrongfully penalize providers and the Medicare- and Medicaid-enrolled people with disabilities that they serve.

If you're a Medicare or Medicaid provider who wants to effect change in these programs, you can join ASHA in taking action to protect Medicaid funding more broadly.

Changing Strategies

Withholding payments to Medicaid agencies as a form of FWA prosecution is a politically explosive and largely unprecedented strategy. For decades, Medicaid oversight has relied primarily on guidance and corrective action plans (known as a "pay and chase" approach) rather than the preemptive withholding of funds. However, Section 1904 of the Social Security Act does allow CMS to withhold federal matching funds when a state fails to comply with its obligations.

CMS' actions in Minnesota, including potential withholding of federal funds, represent a major shift away from the "pay and chase" approach to what is being called a "stop and caught" approach-stopping any payments before they happen.

Understanding Medicare and Medicaid's separate financing structures can help audiologists and SLPs better understand how these strategies can impact them. ASHA's Medicare vs Medicaid resource explains the programs' funding sources, provider considerations, and more.

House Energy and Commerce Committee Leads Congressional Investigation on Medicare and Medicaid Fraud

On February 3, the House of Representatives' Energy and Commerce (E&C) Committee's Subcommittee on Oversight and Investigations held three hearings focusing on fraud in Medicare and Medicaid. Witnesses reported on fraudulent billing schemes and fraud detection while members of Congress asked questions regarding the scope of fraud and methods for eliminating it.

On March 3, the E&C Committee sent letters to governors and Medicaid directors in 10 states (almost all of which are democrat-led). The letters contained a series of state-specific questions that had to be answered by March 17, 2026. The letters requested all audit documentation related to FWA, current program integrity measures, provider enrollment, improper payment rates, and other information.

On March 17, the E&C Committee held another hearing where CMS Deputy Administrator and Chief Operating Officer Kim Brandt testified. She discussed ongoing concerns and procedures across the states to manage FWA, including CMS' strategy of deferring $259.5 million in funding to Minnesota Medicaid for the fourth quarter of fiscal year 2025 and initiating actions to potentially withhold over $2 billion in annual funding.

ASHA Advocacy attended the hearing representing providers and has submitted a statement for the congressional record [PDF]. Audiologists and SLPs can expect more hearings like this and more potential Medicaid cuts over the next year. The best way to keep up with changing Medicaid funding in your state is to check with your state Medicaid agency or check with ASHA through the ASHA Advocate or [email protected].

What ASHA Advocacy Is Doing

As a provider representative organization, ASHA believes strongly in prosecuting FWA in federal and private or commercial health insurance programs. But the strategy of stopping payments to Medicaid agencies will put even more financial pressure on them as they weather almost $1 trillion in cuts as a result of the One Big Beautiful Bill Act.

In addition to responding to the RFI and submitting a statement for the record for the Energy and Commerce Committee's Hearing, ASHA has been meeting with members of Congress and their staff encouraging them not to make any more cuts to these essential safety net programs under the guise of prosecuting FWA.

Questions?

If you have questions, please contact ASHA's health care and education policy team at [email protected].