Oz Didn’t Invent the Medicare Fraud Fight. Is He Changing It?

For decades, the federal government took a simple approach to Medicare and Medicaid fraud: Pay first, chase later.

Now there is, apparently, a “war room.”

In a viral social media clip, a dozen staffers sit around a conference table, laptops open, TV screens behind them. “These open buildings that they claim are medical facilities,” one analyst says on camera. “Nobody’s there.” CMS Administrator Mehmet Oz, MD, MBA, nods. They are, he says, “holding their feet to the fire.”

Another cinematic clip shows an actor portraying a fraudster zipping away on a jet ski — a scene, Oz says, “right out of ‘Miami Vice.'”

In a third with millions of views, Oz rolls through a California neighborhood, pointing out locations he claims are fraud centers.

Those elaborate productions are new. But the message they send is anything but, experts say.

“They may be the first public officials in recent memory to put such an overtly public face on Medicare’s efforts to fight fraud,” Juliette Cubanski, PhD, MPH, deputy director of KFF’s Program on Medicare Policy, told MedPage Today. “And at the same time, they’re certainly not the first ever to focus on it.”

Former White House chief economist for health policy Stephen Parente, PhD, MPH, now at the University of Minnesota in Minneapolis, pointed out that while the federal government has always clawed back funds in fighting fraud, the energy level is different now.

“When you have, essentially, people going around and shooting video clips where it feels like you’re watching something out of ‘Cops’ — that’s new,” he told MedPage Today. “Most things that were talked about with fraud were more like, ‘Here’s a PowerPoint deck and here’s what we recovered,’ and it kind of stayed to the land of the nerds.”

Oz’s social media blitz comes as the Department of Justice reported a record $6.8 billion in settlements and judgments under the False Claims Act in the fiscal year that ended Sept. 30, 2025 — more than twice as much as it reported a year earlier. Since 1986, when Congress strengthened the Act — the federal government’s primary litigation tool for fighting fraud — settlements and judgments have climbed past $85 billion, an average of roughly $2 billion between 1986 and 2024 before the massive jump most recently reported.

The latest semiannual report from the HHS inspector general’s office published in January also shows an anti-fraud infrastructure operating at a massive scale. In the 6 months that ended Sept. 30, 2025 — before most of Oz’s public campaign had fully taken hold — the office generated $2.43 billion in monetary impact, participated in the largest healthcare fraud takedown in the agency’s history, completed 909 investigations, and logged nearly 87,000 tips through its hotline. The return on investment: $12.70 for every dollar spent.

That office is now led by T. March Bell, a Republican attorney and former House Republican counsel appointed after Trump removed Christi A. Grimm days into his term along with 16 other inspectors general across the federal government. Whether the institutional continuity holds is a question the numbers can’t yet answer.

“The reality is,” Parente said, “whoever gets to put out the press release gets to claim it.”

A CMS spokesperson told MedPage Today that under Oz, the agency is implementing “real-time, data-driven fraud prevention measures” that include flagging suspicious billing patterns, strengthening provider screening programs, and veering from the longstanding “pay-and-chase” model.

That reliance on paying and chasing wasn’t an accident. It was a bureaucratic choice, Parente said.

After working on Republican Sen. John McCain’s presidential campaign in 2008, Parente helped develop legislation that would have directed CMS to apply the same kind of preemptive fraud-detection algorithms used by the credit card industry — flagging suspicious claims before payment, rather than recovering money afterward. The bill passed as part of a 2010 law signed by President Barack Obama with bipartisan support. CMS never fully implemented it, in large part because of a fear of wrongly denying legitimate claims, he said.

“The bureaucracy inside CMS was like, ‘We don’t want to fail the headline test,'” Parente said. “We don’t want doctors yelling at us saying this claim that looks suspicious actually isn’t.”

Here’s what not paying and chasing might look like in practice: President Donald Trump’s administration is withholding millions of dollars in Medicaid funding for several states — many of which are controlled by Democrats — due to fraud concerns. The administration has said it is freezing nearly $260 million in Medicaid funding to Minnesota and is cracking down on state programs in New York.

Democrats have claimed the moves are politically motivated. Parente said the administration is “obviously making it somewhat political.”

“It doesn’t surprise me, but the reality is that it still needs an investigation,” he added. “That type of stuff could be detected in any of the 50 states or the territories as well, so it’s certainly not unique to Minnesota.”

In perhaps the most concrete, national-level example of preemptive prevention, Oz issued a 6-month block on any new Medicare enrollments for suppliers of durable medical equipment (DME), prosthetics, orthotics, or other supplies used to treat chronic conditions or assist in injury recovery. It targets what the HHS inspector general’s office identified as a persistent source of fraud in the Medicare program, with transnational criminal organizations submitting more than $10 billion in allegedly fraudulent DME claims in the agency’s largest-ever fraud takedown last year.

The current administration does have one advantage over its predecessors, Cubanski pointed out: Advances in artificial intelligence have made it easier and quicker for investigators to spot patterns in data.

“That tool just did not exist” for previous administrations, she said. “It’s like before you had hammers. What are you going to do with a nail? You could try to push it into the wall, but it’s a lot harder than when you get a hammer — you just pound it once, and you’ve got it nailed into the wall.”

Have the new tactics worked? Ultimately, it’s still too soon to say, and Cubanski pointed out that future success is difficult to quantify. Oz has claimed $300 billion was spent for fraudulent, wasteful, or abusive purposes, but Cubanski cautioned that there is a significant difference between wasteful spending and fraud.

“Any dollar saved when it comes to somebody who’s trying to rip off the government or commit these sorts of financial crimes is worth the investment of the money that’s spent on efforts to stop that activity,” Cubanski said.

“We’ve seen tremendous return on investment for efforts to root out fraud in Medicare and Medicaid,” she continued. “I think it’s just a continuation of that equation. Getting more money back than the money that you’re spending on those activities will demonstrate the success of these additional efforts.”

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