CMS Blocks $1.6 Billion in Medicare Lab Payments, Removing 157 Providers for Suspected Fraud
Updated
Updated · Fox News · Aug 28
CMS Blocks $1.6 Billion in Medicare Lab Payments, Removing 157 Providers for Suspected Fraud
2 articles · Updated · Fox News · Aug 28
Summary
$1.6 billion in potentially improper Medicare lab payments has been blocked or clawed back since Trump returned to office, with $732 million tied to 157 labs ejected from the program.
CMS said the labs billed for tests never performed, unnecessary tests or services charged at inflated rates, and used AI-driven claim screening to flag and stop suspicious billing before payment.
185 payment suspensions after investigations into 600 labs stopped more than $500 million, while post-payment reviews recovered $276 million from 442 suspect labs and law-enforcement referrals prevented another $127 million.
Texas cases illustrated the pattern: one lab had $1.35 million stopped before removal, while another had $3.6 million denied or captured and remains under review.
The lab crackdown is part of a broader anti-fraud push that CMS says saved $42 billion in fiscal 2025; in 2026 it has identified $1.8 billion in overpayments and frozen $371 million across 267 providers.