May in Review Newsletter

CMS has announced a six-month nationwide moratorium on new Medicare enrollments for hospice providers and home health agencies. The pause responds to a surge of fraudulent providers that has drained programs built to serve the country’s most vulnerable patients. But fraud does not stop at the Medicare line. States have documented the same patterns in Medicaid, including rapid enrollment spikes, questionable billing, and providers who cycle through ownership changes to avoid scrutiny. The moratorium creates a window, and CMS and the states need to use it to not only remove bad actors from both programs, but also to build the integrated, modern technology required to catch fraud before payments go out the door.

Innovation That Lasts: Building Accountability into Federal AI Review

The White House is weighing an executive order that would route advanced AI systems through a structured federal vetting process modeled on the FDA drug approval framework. Agencies at every level of government are already embedding AI in decisions about healthcare, housing, and benefits eligibility. A model that clears a national security review is not automatically safe in the hands of a state caseworker managing a Medicaid caseload. The vetting criteria must reflect state and local deployment. A workable framework also needs enforceable standards for human oversight, protection for the institutional knowledge held by experienced state employees and contractors, and clear lines of accountability when AI-assisted decisions produce bad outcomes. Without those guardrails, adoption will not modernize government service delivery, and it risks weakening the capacity that already exists.