CMS seeks to expand tech-driven fight against Medicaid fraud

A top official at the Centers for Medicare and Medicaid Services who is helping lead the charge against waste, fraud and abuse across the agency’s operations said innovative technologies and new tech talent are helping its workforce save billions in taxpayer dollars. Now, CMS is planning to expand its cost-saving, innovation-heavy efforts even further. 

In an interview with Nextgov/FCW on the sidelines of last week’s HIMSS conference in Las Vegas, Kim Brandt — deputy administrator and chief operating officer at CMS — said the agency is looking to intensify its tech-driven push to rein in improper payments, including by taking a closer look at the Medicaid system. 

Much of this work so far has been done through the agency’s Fraud Defense Operations Center, which was launched in March 2025 to proactively identify fraud. Brandt said the unit has helped CMS move toward “prevent and detect, versus the pay and chase [model]” when it comes to stopping improper payments before they are even made. 

“[FDOC] brings together a whole bunch of people to take a look in real time at data as claims are getting submitted,” she said, adding that it allows CMS “to be able to detect spikes or aberrancies in current claim submissions” by utilizing input from a cross-dimensional team of personnel that includes data analysts, fraud investigators, lawyers and clinicians.

Through the work of the FDOC — also known within the agency as the Fraud War Room — and its use of AI tools and enhanced data analysis to drive its efforts, Brandt said CMS has been able to save over $2 billion that would have otherwise gone toward improper payments. 

She noted, in particular, that these efforts resulted in a 99% decrease in billing for skin substitutes — which are used to cover burns and open wounds — since “there were these just impossibly high levels.” 

But reviews of tech-flagged claims don’t exist in a vacuum. 

“AI is great to help us say, ‘Hey, here are areas you want to focus on,’ but then we need to actually validate that,’” Brandt said, adding that a doctor or clinician is the one who reviews the data to determine whether or not the billing makes sense and is worth further scrutiny. 

Last August, CMS launched what it called a “Crushing Fraud Chili Cook-Off Competition” to identify innovative solutions like AI that can be used to detect Medicare fraud. The agency announced in December that actuarial and consulting firm Milliman had won the challenge, and Brandt said the agency is planning to release a white paper summarizing the competition’s results soon.

CMS previously reported that its fraud contractors identified $2.6 billion in overpayments across 3,262 Medicare providers in 2025. Brandt said, however, that the agency can benefit further from tech that analyzes waste, fraud and abuse in the Medicaid program.

“There's a huge amount of fraud at the state level of Medicaid, so we need to figure out how to create better dashboards, how to create better analytics to help us get a handle on that,” she said, adding that CMS is looking at “using better tools and resources to go after this, so that we are truly leading in government in terms of what we're doing and how we're doing it.”

CMS previously estimated there was a total of approximately $37.4 billion in improper Medicaid payments in fiscal year 2025. Brandt said she is hopeful that lessons learned from the recent competition, as well as continuing discussions with vendors, will drive the adoption of more tech and data-driven tools for detecting fraud.

“It would be really good if we could have even more people coming to us with Medicaid solutions,” she said. “Almost everything that comes in to me is Medicare.”

While not every commercial solution will be a perfect match for CMS, Brandt said she is focused on “testing new approaches and really being able to think outside of the box,” including learning from the private sector and seeing what the agency can further onboard.

CMS officials also announced during last week’s HIMSS conference that the agency is opening a new office in Salt Lake City later this year. The area has rapidly developed into a U.S. tech hub, with the region earning the nickname “Silicon Slopes.” 

Brandt said the agency has regional hubs across the country in increasingly tech-heavy cities — like Seattle, San Francisco and Boston — and is hoping to hire more high-skilled workers in these areas. 

“We've never aggressively targeted talent like that before,” she said, adding that “we want to get both people who are already in their career, but also people who are just graduating.”

Brandt said she is also hoping to leverage the work of the U.S. DOGE Service “and the power that they have and then a lot of their networks and stuff” to help onboard workers. 

CMS’ ongoing focus on waste, fraud and abuse comes amid an all-of-government push by the White House to crack down on pilfered federal funds. 

President Donald Trump signed an executive order on Monday creating a new anti-fraud task force, chaired by Vice President JD Vance, that is charged, in part, with crafting “a comprehensive national strategy to stop fraud, waste, and abuse within Federal benefit programs, including programs administered jointly with State, local, tribal, and territorial partners.”