In-home care accounts for majority of flagged California claims
Kennedy said at a press conference that officials used artificial intelligence to identify potential fraud. “We used AI, advanced analytics, and other cutting-edge tools to identify suspicious activity and potential fraud,” he said.
“If those states want that money, they need to provide documentation that these payments are legitimate,” Kennedy said.
In California, most of the suspected fraud was in in-home services, Kennedy said. Kennedy has previously singled out in-home care provision, a focus that has worried families of disabled individuals and angered lawmakers.
Mehmet Oz, administrator of the Centers for Medicare & Medicaid Services (CMS), said at the press conference that payments had been used to “pad the pockets of criminals.” He said, “No más, no more. It stops.”
Oz said the government has identified potential areas at high risk of fraud but that “states have not yet been able to document fully and acceptably to the federal government claims that are unresolved and claims that smell like fraud. And if it smells like fraud, we’re not paying for it any more.”
He described in-home care for persons with illness and disability as “often these are services that your family would typically have provided for you” and said the program “can be abused.”
Kennedy said the health department is also expanding its exclusion authority to override states and remove “bad actors” from federal healthcare programs, including permanently banning them from receiving federal funding.