CW: Fraud & Institutional Bias
The Trump administration has focused on its next target: ending healthcare fraud. President Trump announced the formation of a task force aimed at eliminating fraud, waste, and abuse in all federal benefits. On Tuesday, the administration broadened its Medicare and Medicaid fraud investigation to include Republican-led Florida.
Mehmet Oz, the head of the Centers for Medicare and Medicaid Services, has become the public face of this effort. He has shared numerous videos, social media posts, and regulations promoting the agency’s commitment to tackling fraud in hospice care, home health, durable medical equipment, and other sectors. In January, CMS threatened to withhold about $2 billion in funding for 14 Medicaid services in Minnesota for the upcoming year.
For the disability community, this crackdown feels more like a reason to cut essential services instead of a genuine effort to fight fraud. This sentiment was felt with last year’s bill, which reduced Medicaid funding by $1 trillion over the next decade, forcing state health officials to contemplate cutting vital services such as home healthcare for millions.
Advocates worry that broadly targeting state Medicaid funding, like in Minnesota, could endanger lives. Over a quarter of Americans are disabled, many of whom need home healthcare and other home and community-based services that The Center for Medicare and Medicaid Services has targeted. Access to these services is crucial for the survival, independence, and dignity of disabled and older Americans, and their families.
Representatives from the Disability and Aging Collaborative and the Consortium for Constituents with Disabilities expressed strong opposition to CMS’s sweeping actions to freeze funding for Medicaid HCBS services in Minnesota, as well as threats to freeze funding for services nationwide.
“We’ve been fighting to expand access to these services over decades and decades. It hasn’t been easy, but there has been bipartisan support for expanding these programs and services,” said Natalie Kean, federal health advocacy director at Justice in Aging. “To be constantly trying to defend what we have is exhausting.”
For me, this is personal. I have cerebral palsy and have depended on PCAs (personal care assistants) since childhood. My PCA helps me with toileting, dressing, bathing, meal preparation, and transportation. These basic tasks make independent living possible.
Massachusetts is considering cuts to MassHealth. A working group has proposed approximately $32 million in cuts, including lowering the weekly PCA overtime limit from 66 to 60 hours and cutting back on time for tasks like meal preparation.
These changes may seem inconsequential on paper, but they have serious consequences. The PCA workforce is already stretched thin, and many disabled people find it hard to get the hours they need. Reducing overtime means people may have to find additional PCAs, which is often impossible. For me, it would mean my live‑in PCA would lose thousands of dollars in wages, making it harder to retain reliable support.
Committee chairman Rep. John Joyce (R-Pa.) claimed fraud is “running rampant,” while Rep. Randy Weber (R-Texas) stated that “thieves are making off with taxpayer dollars.” However, experts note there are no reliable measurements of fraud in Medicaid or Medicare.
Some of the dramatic figures cited by the Trump administration, such as the $285.2 million in overpayments for autism therapy in Colorado reported by the Department of Health and Human Services Office of Inspector General, do not necessarily indicate fraud. Instead, these numbers may reflect improper or possibly improper payments, often due to missing documentation rather than the actions of “thieves.”
State and federal officials have had ongoing programs to investigate health care fraud. The Department of Health and Human Services Office of Inspector General reported over 1,100 convictions and $1.4 billion in recoveries during the 2024 fiscal year.
“Any dollar lost fraudulently for home and community-based services is a dollar that doesn’t reach someone in need,” said Kendra Davenport, CEO and president of Easterseals, a nonprofit that provides services such as home care nationwide. “We definitely want to reduce fraud and acknowledge that some may exist, but we take issue with broad claims of fraud, waste, and abuse because they can harm programs that millions of Americans depend on.”
Brandt spent significant time during the hearing discussing ways to prevent fraud by shifting from a “pay and chase” method to a more proactive “stop and cop” strategy, where fraudulent payments are canceled before distribution. She highlighted a “really cool series of algorithms” that, similar to how Netflix suggests movies, identifies high-risk individuals that require monitoring.
Brandt did not detail how these algorithms operate or the criteria they use to label something as high risk. Minnesota, California, New York, and now Florida have received notifications that they are or may be under investigation for fraud. Brandt mentioned that CMS would send similar inquiries to other states.
“It feels like a complete turnaround from decades of bipartisan agreement across administrations, during which there has been a strong commitment to helping people remain in their communities and homes instead of being pushed into institutional settings,” said Alison Barkoff, the former head of the federal Administration for Community Living.
The disagreement around Medicaid fraud reveals a deeper tension in American health policy: the need to balance program integrity with the moral and practical obligation to support people who rely on these services. While fighting fraud is important, the methods and language used to pursue it have real effects on the millions of disabled and older Americans who need care.
As federal scrutiny increases, advocates warn that the country may lose sight of what these programs were created to do. Medicaid has long been the backbone of long-term care in the United States. It allows people to stay in their homes, be part in their communities, and maintain their independence. Policies that create broad suspicion or threaten large funding cuts unintentionally undermine that mission.
The Medicaid cuts are not just about fraud, but about priorities. The cuts raise important questions about how the nation values care, how it supports its most vulnerable residents. The choices made in the coming months will affect not only the future of Medicaid oversight but also the daily lives and dignity of millions of Americans.
Sources:
Broderick, O. Rose. “As Trump Administration Cracks down on Health Care Fraud, People with Disabilities Feel Singled Out.” STAT, Boston Globe Media , 18 Mar. 2026, http://www.statnews.com/2026/03/18/trump-health-fraud-crackdown-disability-concerns/.
Laughlin, Jason. “MassHealth Is Losing Billions. Cuts May Be Guided by Those It Serves .” The Boston Globe, Boston Globe Media , 5 Mar. 2026, http://www.bostonglobe.com/2026/03/05/metro/masshealth-pca-program-cuts-trump/?
Maniates, Hannah. “Why Did They Do It That Way? Home and Community-Based Services.” National Association of Medicaid Directors, National Association of Medicaid Directors, 16 Apr. 2024, medicaiddirectors.org/resource/why-did-they-do-it-that-way-home-and-community-based-services/.