AHCA/NCAL
submitted comments to the Centers for Medicare & Medicaid Services (CMS) in response to a
Request for Information (RFI) on the Comprehensive Regulations to Uncover Suspicious Healthcare (CRUSH) initiative [RIN 0938-AV97]. The CRUSH RFI seeks stakeholder feedback on potential policy approaches to strengthen detection, prevention, and enforcement of fraud-waste, and abuse (FWA) across federal health care programs.
Areas of focus include provider screening, ownership verification, identity proofing, and oversight. The request also reflects broader CMS priorities related to FWA, including DMEPOS supplier oversight, AI-assisted coding risks, and beneficiary protection measures.
Key AHCA/NCAL recommendations from this response include:
- Target fraud-prevention approaches, including AI-based program integrity tools, toward high-risk actors rather than applying broad, one-size-fits-all requirements that impose unnecessary burden on compliant providers;
- Calibrate AI-driven program integrity applications to the unique Medicare/Medicaid patient population characteristics and provider size variance within the long term and post-acute care (LTPAC) sector;
- Pursue the least burdensome approaches for information-sharing between CMS, states, and providers to prevent bad actors from entering or remaining the Medicare and Medicaid programs; and
- Ensure appropriate safeguards for both fee-for-service and managed care providers and payers when AI is used, including requiring human oversight and approval of any AI-guided program integrity actions that may affect provider enrollment, audit targeting, or automated denials.