CMS mandates state Medicaid directors to validate providers
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CMS mandates state Medicaid directors to validate providers The latest crackdown on Medicaid fraud directs states to submit a plan within 30 days on a provider revalidation strategy. Medicare & Medicaid By Susan Morse , Executive Editor | May 1, 2026 | 11:17 AM Photo: Alex Wong/Getty Images Centers for Medicare and Medicaid Services Administrator Mehmet Oz has sent state Medicaid directors a letter mandating they submit a plan within 30 days on a two-year provider revalidation strategy.CMS wants to ensure that only legitimate, qualified providers are enrolled and participating in Medicaid, Oz said in the April 23 letter.Oz made the announcement public at Politico‘s Health Care Summit on April 21.“We’re asking the states to own that problem… red and blue, all of them,” Oz said at the Politico summit. “If you don’t take it seriously, it indicates to us that we might have to take the audits… more aggressively.” CMS is reportedly aiming its initiative at home-based and other providers rather than hospitals, but Oz makes no differentiation in the letter. The question becomes whether states will need to re-screen providers that federal programs have already vetted, according to Beckers.The latest CMS initiative follows a Medicaid crackdown on fraud in Minnesota and letters sent to California, Florida, Maine and New York alleging fraud in their Medicaid programs.While CMS recognizes that most Medicaid providers are “honest, hardworking and dedicated to rendering high-quality care to beneficiaries," Oz said in the letter to state Medicaid directors, national trends “strongly suggest a persistent and growing Medicaid threat posed by sophisticated actors knowingly exploiting these complex systems for financial gain.” State Medicaid directors are to undertake a “swift revalidation of high-risk providers within 10 days of receipt of the letter and submit a comprehensive two-year strategy within 30 days; and provide a strategy results upon completion.Oz wants state Medicaid directors to submit a description of how they are ensuring accuracy of their provider enrollment data through revalidation and other approaches, such as provider directories.CMS wants off-cycle provider revalidation, with a focus on high-risk providers without a National Provider Identifier (NPI); metrics to measure the effectiveness of the state strategy; an approach to verifying provider information and are ensuring consistency and accuracy; and information on how they’re coordinating efforts with law enforcement partners.Governors also received this letter. Email the writer: [email protected] Topic: Business Intelligence, Compliance & Legal, Medicare & Medicaid