WASHINGTON—The Centers for Medicare & Medicaid Services (CMS) has formally submitted a request to all states to develop a plan to revalidate Medicaid providers in areas they deem to be at risk.
In a letter sent April 23 to all state Medicaid directors and posted on X, CMS Administrator Mehmet Oz asked states to “develop and submit a comprehensive two-year provider revalidation strategy” for Medicaid providers in an effort to reduce fraud and abuse in the program. Oz first announced the audit program April 22 while on stage at the Politico Health Summit.
The strategies should be tailored to the landscape of each state and should prioritize a comprehensive review and revalidation of enrolled providers, he said in the letter, a version of which also went to state governors. The letter also urges states to increase oversight for high-risk provider types and to emphasize high-risk providers who have not been screened in the past year and those without National Provider Identification numbers.
“Governors, I’m calling on you to act now,” Oz said in a video posted on his official X account. “Fraudsters and other bad actors are draining Medicaid funds, costing taxpayers billions every year.”
In both the letter and the video, Oz said states should:
- Notify CMS of plans to undertake the project within 10 days of receiving the letter
- Submit their comprehensive two-year provider revalidation strategy within 30 days of receipt
- Provide results upon completion
Oz didn’t additionally specify which areas of care or locations to focus on, telling governors in the video that they know their states best. The letter calls out “classes of providers with less rigorous enrollment and billing requirements (e.g. providers without National Provider Identifiers” as being most vulnerable to fraud.