Federal activity surrounding Medicaid fraud continues to accelerate, with increased attention from Congress, the Centers for Medicare & Medicaid Services (CMS), and national policy leaders — placing home- and community-based services (HCBS) squarely in the conversation.

Congressional Hearing Highlights Growing Focus on HCBS

The House Energy and Commerce Committee recently convened a hearing examining fraud in Medicare and Medicaid, with CMS Chief Operating Officer Kim Brandt providing testimony. While her prepared remarks did not specifically address HCBS, home care and related services were repeatedly referenced by members during opening statements, signaling heightened scrutiny of the sector.

This reflects a broader trend in Washington, where policymakers are increasingly focused on program integrity in Medicaid — particularly in high-growth areas like home- and community-based care.

CMS Expands Oversight Efforts to Florida

At the same time, CMS has formally requested detailed information from Florida regarding its Medicaid program integrity efforts, marking an expansion of similar inquiries previously directed to states such as Minnesota, California, Maine, and New York.

The letter outlines concerns about fraud, waste, and abuse, citing recent enforcement actions and high-profile cases involving telemedicine, durable medical equipment, and HCBS. According to the letter, coordinated federal enforcement efforts have identified billions of dollars in alleged fraudulent activity, including schemes involving services billed but not rendered and deceptive marketing practices.

CMS is seeking comprehensive information on Florida’s oversight infrastructure, including:

• Program integrity staffing, funding, and coordination across agencies
• Provider screening, enrollment, and revalidation processes
• Monitoring and oversight of high-risk services, including personal care and HCBS
• Use of data analytics, audits, and fraud detection tools
• Payment suspensions, investigations, and recovery efforts

Florida has been asked to respond within 30 days, signaling a near-term escalation in federal-state engagement on program integrity.

Policy Debate Emerging Around Scope of Fraud

At the same time, the national conversation around Medicaid fraud is becoming more complex. A recent article published in Health Affairs argues that fraud in Medicaid — particularly within HCBS — is not as widespread as some federal policymakers have suggested, warning that overstated concerns could threaten access to essential services.

While perspectives differ, the issue is clearly gaining traction across federal agencies, Congress, and policy circles, with potential implications for regulation, oversight, and provider operations.

What This Means for Providers

For home health and HCBS providers, these developments point to a rapidly evolving federal landscape:

• Increased scrutiny of billing practices and documentation
• Expanded oversight of high-risk service categories, including personal care
• Greater emphasis on data analytics, audits, and program integrity infrastructure
• Potential policy and regulatory changes tied to fraud prevention efforts

HCAF is actively engaged with national partners and federal stakeholders to ensure that efforts to combat fraud are balanced with the need to protect access to care and support legitimate providers delivering high-quality services.

Additional updates and opportunities for member engagement will be shared in the coming weeks.