HHS Cracks Down on Healthcare Fraud While Expanding Patient Access and Drug Reforms

Welcome to this week's HHS update. The biggest story dominating the department right now involves a major crackdown on Medicare and Medicaid fraud, announced just last week by the Centers for Medicare and Medicaid Services. CMS identified over 1.5 billion dollars in suspected fraudulent billing within durable medical equipment alone, prompting them to impose a six month nationwide moratorium on new Medicare enrollment for certain equipment suppliers effective immediately. This is part of a three pronged attack on healthcare fraud that also includes deferring 259 and a half million dollars in quarterly federal Medicaid matching funds to Minnesota while the agency completes a program integrity review in that state. Beyond fraud prevention, Congress recently passed significant healthcare legislation that touches nearly every American with health coverage. The new spending bill extends COVID-19 telehealth flexibilities through the end of 2027, meaning patients can continue accessing care remotely without the geographic restrictions that used to apply. For mental health specifically, in-person visit requirements are delayed until January 2028. The legislation also authorizes Medicare coverage for multi-cancer early detection screening tests, a major advancement for preventive care. The bill tackles another issue frustrating patients and pharmacists alike through comprehensive pharmacy benefit manager reforms. Starting in 2028, PBMs will be required to operate on flat service fees rather than fees tied to drug costs, disclose detailed pricing information, and allow any willing pharmacy to participate in Medicare plans. Community Health Centers are receiving increased funding reaching 4.6 billion dollars for fiscal 2026, strengthening access to primary care across the country. There are also updates to how health insurance works on the marketplace. The HHS Notice of Benefit and Payment Parameters for 2026 finalizes new safeguards protecting consumers from unauthorized changes to their coverage and makes HealthCare dot gov easier to navigate for plan comparisons and enrollment. For listeners who care about specific health conditions, the new risk adjustment models now include HIV prevention medication as a separate factor, reducing insurance company incentives to restrict access to these critical preventive drugs. The timeline matters here. Pharmacy reforms kick in over the next two years, so stakeholders are watching closely as CMS develops the rules. The fraud investigation comment period closes March 30th, giving the public a chance to weigh in on potential new anti-fraud tools. If you have Medicare, use marketplace coverage, or care about prescription drug costs, these developments will likely affect you. For details on any of these policies, listeners can visit HHS dot gov or CMS dot gov. Thank you for tuning in. Please subscribe for more updates. This has been a Quiet Please production. For more, check out quietplease dot ai. For more http: This content was created in partnership and with the help of Artificial Intelligence AI.