The Centers for Medicare and Medicaid Services (“CMS“) issued a wide-ranging Request for Information (“RFI”) on February 26, which could reshape current program integrity efforts to prevent and detect fraud, waste and abuse in government health care programs. CMS, under its new Comprehensive Regulations to Uncover Suspicious Healthcare (“CRUSH”) initiative, is seeking stakeholder input on potential regulatory and operational changes aimed at strengthening program integrity across Medicare, Medicaid, CHIP and the Health Insurance Marketplace (“Marketplace”). The RFI spans topics such as provider enrollment, ownership verification, Medicare Advantage oversight, laboratory testing, DMEPOS suppliers, claim‑filing deadlines, artificial intelligence in coding, beneficiary protections and Marketplace and Medicaid oversight—signaling CMS’s interest in significant updates to its fraud‑prevention tools.
The results of these efforts could have far-reaching and lasting implications for the health care industry. We encourage organizations to review the RFI and its full scope of topics. This RFI offers health care stakeholders an opportunity to provide feedback on potential regulatory changes that might be included in a future proposed rule, as well as other federal health care program changes. Comments are due March 30, 2026.
Key Topics :
- Program integrity enhancements—Strengthening screening, payment suspensions, audits, analytics and other tools to act more quickly against fraud.
- Identity proofing and ownership controls—Considering stronger identity verification, expanded background checks and potential citizenship or residency requirements for owners.
- Preclusion list and Medicare Advantage (“MA”) enrollment—Evaluating changes to prevent revoked providers from billing MA plans and assessing whether MA providers should enroll in Traditional Medicare.
- Genetic and molecular test oversight—Seeking input on new authorities, analytics and the role of MolDX in addressing high risk laboratory testing.
- Non-participating DMEPOS suppliers—Considering stronger oversight and alignment with Traditional Medicare standards to address MA billing fraud.
- Shorter claim filing deadlines—Exploring a reduction of the one year filing window for high-risk items and services to 90–180 days.
- AI in coding and billing—Assessing how AI can support accurate coding, reduce errors and detect improper payments.
- Beneficiary solicitation protections—Considering expansion of the DMEPOS telephone solicitation ban to additional communication channels and provider types.
- Beneficiary contact about suspicious claims—Exploring new communication methods that balance trust, privacy and administrative burden.
- Surety bond requirements—Evaluating increases to the DMEPOS bond amount and expansion to additional provider types.
- State-specific Medicaid/CHIP issues—Seeking state input on Medicaid and CHIP program integrity needs, oversight of supplemental payments and Marketplace risks including agent behavior, enrollment changes and income verification.
Practical Takeaways
- Expect significant rulemaking activity. The breadth of the RFI suggests CMS is preparing for significant program integrity reforms across multiple programs.
- Operational impacts could be substantial. Proposed concepts, such as ownership restrictions, shorter filing deadlines, expanded preclusion rules and new accreditation or enrollment requirements, could require major compliance adjustments.
- Early engagement is beneficial. Organizations should assess how the proposed topics may affect their operations and consider submitting comments to assist CMS in its initiative.
If you have any questions or would like assistance drafting comments or evaluating potential impacts on your organization, please contact:
- Katherine Kuchan at (414) 721-0479 or kkuchan@hallrender.com;
- Ritu Kaur Cooper at (232) 370-9584 or rcooper@hallrender.com;
- Kaitlin Nucci at (248) 457-7838 or knucci@hallrender.com; or
- Your primary Hall Render or Hall Render Advisory Services contact.
Special thanks to summer associate McKenna Schaefer for his assistance with this article.
Hall Render blog posts and articles are intended for informational purposes only. For ethical reasons, Hall Render attorneys cannot—outside of an attorney-client relationship—answer specific questions that would be legal advice.
