In a move aimed at reshaping how care is financed and delivered across public health programs, the U.S. Department of Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS) have launched a formal request for nominations to the newly formed Healthcare Advisory Committee. The group will report directly to HHS Secretary Robert F. Kennedy Jr. and CMS Administrator Dr. Mehmet Oz with the mandate of generating strategic policy recommendations across Medicare, Medicaid, the Children’s Health Insurance Program (CHIP), and the Health Insurance Marketplace.

The Centers for Medicare & Medicaid Services (CMS) has launched a nationwide initiative aimed at enforcing federal eligibility rules and rooting out enrollment inaccuracies in both Medicaid and the Children’s Health Insurance Program (CHIP). At the heart of this new effort is a monthly verification process that flags beneficiaries whose citizenship or immigration status cannot be confirmed through standard federal systems such as the Department of Homeland Security’s Systematic Alien Verification for Entitlements (SAVE) program.

The recent guilty plea by Oklahoma City behavioral health counselor Natasha Allmon for submitting over $1 million in fraudulent claims to Blue Cross Blue Shield (BCBS) offers a stark reminder of the persistent vulnerabilities in U.S. healthcare billing systems. Between January 2021 and December 2023, Allmon filed thousands of claims, many of which cited implausible treatment volumes, including 24-hour days of psychiatric counseling delivered to family members.

The core federal safeguard for electronic protected health information, the HIPAA Security Rule, had not been materially updated since 2013. Only in January 2025 did HHS publish a Notice of Proposed Rulemaking to modernize requirements such as multi-factor authentication, encryption, vendor notification, and tested contingency planning. Proposed rules are not protections.

The federal indictment of a Pittsburgh-based residential care owner on charges of Medicaid fraud, false health care statements, money laundering, and Social Security abuse is more than a criminal proceeding. It highlights structural vulnerabilities in how state Medicaid agencies oversee home- and community-based services (HCBS).

The Centers for Medicare & Medicaid Services (CMS) confirmed in mid-July that it has executed a memorandum of understanding giving U.S. Immigration and Customs Enforcement (ICE) direct query access to the national Medicaid eligibility database. The agreement allows ICE to retrieve names, home addresses, dates of birth and Social Security numbers for any beneficiary flagged as a “person of interest” by immigration analysts.

Federal law-enforcement agencies have battled waves of durable medical equipment fraud for more than a decade, yet recent court actions demonstrate that orthotic brace schemes remain highly lucrative. A Tampa judge has sentenced Palm City resident Lino Mallari Gutierrez to 17 years and 6 months in prison for orchestrating an operation that obtained more than $10.8 million from Medicare in just six months.

Federal prosecutors have spent much of 2025 spotlighting aggressive health-care fraud enforcement, culminating in a multistate takedown that charged 324 defendants and highlighted more than $14 billion in alleged losses to insurers and government programs. The Justice Department framed the sweep as proof that complex billing schemes continue to siphon scarce resources away from legitimate patient care.