{"id":2696769,"date":"2026-11-03T08:53:56","date_gmt":"2026-11-03T13:53:56","guid":{"rendered":"https:\/\/www.conservativenewsdaily.net\/breaking-news\/utm_sourcerssutm_mediumrssutm_campaignone-ongoing-scam-cost-medicare-15-billion-can-washington-shut-it-down\/"},"modified":"2026-11-03T09:05:07","modified_gmt":"2026-11-03T14:05:07","slug":"utm_sourcerssutm_mediumrssutm_campaignone-ongoing-scam-cost-medicare-15-billion-can-washington-shut-it-down","status":"publish","type":"post","link":"https:\/\/www.conservativenewsdaily.net\/breaking-news\/utm_sourcerssutm_mediumrssutm_campaignone-ongoing-scam-cost-medicare-15-billion-can-washington-shut-it-down\/","title":{"rendered":"One Ongoing Scam Cost Medicare $15 Billion"},"content":{"rendered":"<aside class=\"mashsb-container mashsb-main mashsb-stretched\"><div class=\"mashsb-box\"><div class=\"mashsb-count mash-medium\" style=\"&quot;\"><div class=\"counts mashsbcount\">14<\/div><span class=\"mashsb-sharetext\">SHARES<\/span><\/div><div class=\"mashsb-buttons\"><a class=\"mashicon-facebook mash-medium mash-nomargin mashsb-noshadow\" href=\"https:\/\/www.facebook.com\/sharer.php?u=https%3A%2F%2Fwww.conservativenewsdaily.net%2Fbreaking-news%2Futm_sourcerssutm_mediumrssutm_campaignone-ongoing-scam-cost-medicare-15-billion-can-washington-shut-it-down%2F\" target=\"_top\" rel=\"nofollow\"><span class=\"icon\"><\/span><span class=\"text\">Facebook<\/span><\/a><a class=\"mashicon-twitter mash-medium mash-nomargin mashsb-noshadow\" href=\"https:\/\/twitter.com\/intent\/tweet?text=&amp;url=https:\/\/www.conservativenewsdaily.net\/breaking-news\/?p=2696769&amp;via=ConservNewsDly\" target=\"_top\" rel=\"nofollow\"><span class=\"icon\"><\/span><span class=\"text\">Twitter<\/span><\/a><a class=\"mashicon-subscribe mash-medium mash-nomargin mashsb-noshadow\" href=\"#\" target=\"_top\" rel=\"nofollow\"><span class=\"icon\"><\/span><span class=\"text\">Subscribe<\/span><\/a><div class=\"onoffswitch2 mash-medium mashsb-noshadow\" style=\"display:none\"><\/div><\/div>\n            <\/div>\n                <div style=\"clear:both\"><\/div><\/aside>\n            <!-- Share buttons by mashshare.net - Version: 4.0.47--><p>A well-known line often (and incorrectly) linked to thomas Jefferson &#8211; that eternal vigilance is the price of liberty &#8211; fits equally well for the effort to stop waste, fraud, and abuse in government programs. Each time lawmakers or law enforcement tighten rules, scammers shift to new tactics.<\/p>\n<p>A recent House Energy and Commerce Committee report paints a mixed picture. Some policy changes and tougher enforcement have produced protections for people and taxpayers, but the committee\u2019s simultaneous roll-out of 14 anti-fraud proposals shows more work remains.<\/p>\n<p>One clear positive: spending on skin substitutes has plunged after reforms. Skin substitutes are wound-care products (biologic, synthetic, or tissue-engineered) used for chronic wounds. Under a past Medicare rule that let providers set unlimited prices for any new skin substitute during its first six months, spending exploded &#8211; rising from about $256 million in 2021 to an estimated $15.4 billion in 2025. Some providers took advantage, billing extremely large amounts (reports cited cases of millions charged for a single patient) by introducing repeatedly labeled \u201cnew\u201d products. Starting this year, CMS tightened payment rules so those unlimited initial charges are no longer allowed. The Medicare trustees say spending on skin substitutes should drop more than 90% in 2026, and CMS leadership has noted that the reduction has helped lower Medicare Part B premiums by roughly $11 a month.<\/p>\n<p>But the report also documents serious state-level shortcomings. Many states aren\u2019t properly classifying provider risk as federal rules require.Risk classification is a basic anti-fraud tool that focuses oversight on the most vulnerable areas; <a href=\"https:\/\/amzn.to\/3YuVZYV\" >high-risk providers typically face extra steps<\/a> such as <a href=\"https:\/\/www.conservativenewsdaily.net\/breaking-news\/new-mexicos-herrell-wants-answers-from-mayorkas-on-immigrants-entering-u-s-without-medical-crime-checks\/\" title=\"New Mexico\u2019s Herrell Wants Answers from Mayorkas on Immigrants Entering U.S. Without Medical, Crime Checks\">criminal background checks<\/a> and fingerprinting. Some states &#8211; New York among them &#8211; failed to assign risk levels for several Medicaid-only provider categories (services that don\u2019t have Medicare equivalents and so can\u2019t reuse Medicare classifications). Those Medicaid-only services include areas at high risk for abuse, like in-home personal care and applied behavior analysis for autism. Failing to measure and categorize risk undermines efforts to protect taxpayer dollars and beneficiaries.<\/p>\n<p>combating fraud takes persistence and ongoing adaptation to criminals\u2019 changing strategies. There won\u2019t be a single decisive victory; progress will come through many small, sustained improvements that change program culture, inform the public, and deter wrongdoers.The hope is that program integrity keeps moving forward.<\/p>\n<p>Author note: Chris Jacobs is founder and CEO of Juniper Research Group and wrote The Case Against Single Payer. He is on Twitter as @chrisjacobsHC.  <\/p>\n<p class=\"readmore\">\n    <button onclick=\"showReadMore()\" id=\"readmorebtn\">Read more&#8230;<\/button>\n<\/p>\n<hr id=\"line\">\n<span id=\"more\"><\/p>\n<div>\n<p>The popular quotation (<a href=\"https:\/\/www.monticello.org\/encyclopedia\/eternal-vigilance-price-liberty-spurious-quotation\" target=\"_blank\" rel=\"noreferrer noopener\">incorrectly attributed<\/a> to Thomas Jefferson) that eternal vigilance is the price of liberty and freedom could equally apply to the fight against waste, fraud, and abuse in government programs. Whenever lawmakers pass new measures to prevent waste, or law enforcement cracks down on fraud, scammers tend to migrate to some new scheme.<\/p>\n<p>On that front, a <a href=\"https:\/\/d1dth6e84htgma.cloudfront.net\/EC_Fraud_Staff_Report_9_29_26_468cdcbe40.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">report<\/a> recently issued by the House Energy and Commerce Committee summarizing activities in recent months provides a mixed perspective. In some respects, changing policies and greater enforcement have protected individuals and taxpayers. But the fact that committee members <a href=\"https:\/\/energycommerce.house.gov\/posts\/e-and-c-republicans-introduce-critical-fraud-fighting-package-to-protect-vulnerable-americans-and-safeguard-taxpayer-dollars\" target=\"_blank\" rel=\"noreferrer noopener\">introduced<\/a> 14 anti-fraud measures in conjunction with the report\u2019s release shows that Washington still has more work to do.<\/p>\n<h2><strong>Skin Substitute Spending Plummets<\/strong><\/h2>\n<p>The Energy and Commerce report highlighted one point of good news that has emerged in recent months. As a result of reforms put into place by the Trump administration, Medicare spending on skin substitutes has plummeted.<\/p>\n<p>\u201cSkin substitutes\u201d are a category of wound-care products such as biologic, synthetic, or tissue-engineered materials applied to chronic, non-healing wounds. As I had <a href=\"https:\/\/thefederalist.com\/2026\/03\/18\/sen-bill-cassidy-defends-medicare-scammers-over-americas-seniors\/\" target=\"_blank\" rel=\"noreferrer noopener\">previously reported<\/a>, this specific category of substitutes has a history of enormous waste and fraud thanks to a Medicare policy that put no cap on what providers could charge for newly introduced skin substitute products in their first six months on the market. Thus, the category experienced a <em>more than 60-fold increase<\/em> in spending during the Biden years, from <a href=\"https:\/\/archive.ph\/kO8Ok\" target=\"_blank\" rel=\"noreferrer noopener\">$256 million in 2021<\/a> to an estimated <a href=\"https:\/\/www.naacos.com\/press-releases-letters-2025\/news-release-skin-substitute-spending-on-track-to-hit-15-billion-in-2025\/\" target=\"_blank\" rel=\"noreferrer noopener\">$15.4 billion in 2025<\/a>. <\/p>\n<p>Medical providers were introducing \u201cnew\u201d \u2014 and of course more expensive \u2014 skin substitutes every six months, because the providers could charge whatever they wanted for the product\u2019s first half-year and Medicare would pay it. Physicians, who could buy the products at a discounted price and charge Medicare the full rate, were placing as much as <a href=\"https:\/\/archive.ph\/3Y3nv\" target=\"_blank\" rel=\"noreferrer noopener\">$14 million<\/a> in \u201cskin substitutes\u201d on a single patient to get in on the action.<\/p>\n<p>Beginning this year, the Centers for Medicare and Medicaid Services (CMS) <a href=\"https:\/\/www.cms.gov\/newsroom\/press-releases\/cms-modernizes-payment-accuracy-significantly-cuts-spending-waste\" target=\"_blank\" rel=\"noreferrer noopener\">changed its payment policies<\/a> such that providers could no longer charge unlimited amounts for skin substitutes. And in June, the annual Medicare <a href=\"https:\/\/www.cms.gov\/oact\/tr\/2026\" target=\"_blank\" rel=\"noreferrer noopener\">trustees report<\/a> compiled by program actuaries noted that due to the \u201csignificant policy changes to skin substitute payments starting in 2026 \u2026 spending for skin substitutes will decline by more than 90 percent in 2026.\u201d A recent <a href=\"https:\/\/x.com\/DrOzCMS\/status\/2100329056868687922\" target=\"_blank\" rel=\"noreferrer noopener\">video<\/a> by CMS Administrator Mehmet Oz noted that this difference in spending alone has moderated Medicare Part B premiums by $11 per month, or $132 per year. The difference amounts to real savings for America\u2019s seniors \u2014 not to mention American taxpayers.<\/p>\n<h2><strong>Not Classifying Provider Risk<\/strong><\/h2>\n<p>On the other hand, the Energy and Commerce report also highlights ways where states continue to fall short in fighting fraud. After sending inquiries to several states about their Medicaid program integrity efforts, the committee received back some disturbing responses. For instance, states are not properly classifying providers\u2019 risk levels, in violation of federal regulations.<\/p>\n<p>Risk classification serves not just as a common anti-fraud tool, but also as a common-sense one: governments should focus their efforts on those categories of providers with the biggest program integrity concerns. For instance, high-risk categories of providers require criminal background checks and fingerprinting, in addition to verifying the provider\u2019s medical licensure and similar steps.<\/p>\n<p>Yet states like New York did not even bother to classify risk for several categories of provider that serve only Medicaid and not Medicare patients. (States can piggyback off of CMS\u2019s Medicare provider classifications, but by definition they cannot do so for services that only Medicaid and not Medicare provide.) Those Medicaid-only services include some of those most at-risk for waste, fraud, and abuse, including in<a href=\"https:\/\/www.conservativenewsdaily.net\/breaking-news\/republicans-pivot-to-combating-fraud-as-midterm-elections-approach\/\" title=\"Republicans pivot to combating ... as midterm elections approach\">-home personal care services<\/a> and <a href=\"https:\/\/thefederalist.com\/2026\/04\/01\/your-medicaid-taxes-paid-for-an-autism-therapy-execs-2-5m-beach-home\/\" target=\"_blank\" rel=\"noreferrer noopener\">applied behavior analysis<\/a> for patients with autism.<\/p>\n<p>As the saying goes, you can\u2019t manage it if you don\u2019t measure it. States that aren\u2019t even classifying their providers by risk level \u2014 as they are required to do \u2014 demonstrate a cavalier attitude toward protecting scarce taxpayer funds, not to mention beneficiaries themselves.<\/p>\n<p>Fighting fraud requires persistence and a willingness to adapt and respond to criminals\u2019 own changes in tactics and strategies. Victory in the struggle will never come via a battlefield surrender or a \u201cMission Accomplished\u201d moment. Instead, it will arrive through myriad small, incremental changes that over time change the culture within government programs, awaken and educate the public, and simultaneously dissuade criminals. Here\u2019s hoping that program integrity continues to take more steps forward than back.<\/p>\n<hr>\n<div>\n<p>      Chris Jacobs is founder and CEO of Juniper Research Group and author of the book &#8220;<a href=\"https:\/\/www.amazon.com\/dp\/1645720020\">The Case Against Single Payer<\/a>.&#8221; He is on Twitter: <a href=\"http:\/\/twitter.com\/chrisjacobsHC\">@chrisjacobsHC<\/a>.<\/p>\n<\/div><\/div>\n<p><\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Vigilance guards liberty by fighting waste and fraud<\/p>\n","protected":false},"author":521,"featured_media":2696770,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_mo_disable_npp":"","fifu_image_url":"https:\/\/thefederalist.com\/wp-content\/uploads\/2026\/10\/111014-F-ML202-020-scaled.jpeg","fifu_image_alt":"","footnotes":""},"categories":[546],"tags":[7969,6909,4606,4159,9895],"class_list":["post-2696769","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-the-federalist","tag-costs","tag-fraud","tag-healthcare","tag-medicare","tag-scam"],"fifu_image_url":"https:\/\/thefederalist.com\/wp-content\/uploads\/2026\/10\/111014-F-ML202-020-scaled.jpeg","_links":{"self":[{"href":"https:\/\/www.conservativenewsdaily.net\/breaking-news\/wp-json\/wp\/v2\/posts\/2696769","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.conservativenewsdaily.net\/breaking-news\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.conservativenewsdaily.net\/breaking-news\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.conservativenewsdaily.net\/breaking-news\/wp-json\/wp\/v2\/users\/521"}],"replies":[{"embeddable":true,"href":"https:\/\/www.conservativenewsdaily.net\/breaking-news\/wp-json\/wp\/v2\/comments?post=2696769"}],"version-history":[{"count":3,"href":"https:\/\/www.conservativenewsdaily.net\/breaking-news\/wp-json\/wp\/v2\/posts\/2696769\/revisions"}],"predecessor-version":[{"id":2696786,"href":"https:\/\/www.conservativenewsdaily.net\/breaking-news\/wp-json\/wp\/v2\/posts\/2696769\/revisions\/2696786"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.conservativenewsdaily.net\/breaking-news\/wp-json\/wp\/v2\/media\/2696770"}],"wp:attachment":[{"href":"https:\/\/www.conservativenewsdaily.net\/breaking-news\/wp-json\/wp\/v2\/media?parent=2696769"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.conservativenewsdaily.net\/breaking-news\/wp-json\/wp\/v2\/categories?post=2696769"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.conservativenewsdaily.net\/breaking-news\/wp-json\/wp\/v2\/tags?post=2696769"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}