NAMPI Survey | March 2026

RFI for StakeHolder Feedback: CRUSH Proposed Rule & Regulatory Changes

NAMPI is soliciting anonymous feedback to compile and review with NAMD and
NAMFCU for a submission in response to the latest RFI from CMS. This request
for information (RFI) solicits stakeholder feedback on potential regulatory
changes that might be included in a potential upcoming CRUSH proposed rule,
as well as other programmatic changes that could be implemented to make CMS
more effective in crushing fraud to protect taxpayer dollars and the Americans we
serve.
Section 1: Modifications to Program Integrity Requirements
YesNo
[1.1a] If Yes: Please describe the specific statutory authorities and how they could be better utilized.
[1.2] Are there ways to modify provider enrollment (including revocation), medical review, investigation, audit, payment suspension, and other program integrity oversight policies to provide CMS with increased authority and flexibility to expeditiously prevent bad actors from engaging in fraud, waste, and abuse?(See, for example, Title 42 Code of Federal Regulations (CFR) 405.371 et seq.(payment suspension), part 424, Subpart P, especially 424.510 (general requirements), 424.516 (additional requirements), 424.530 (enrollment denial),424.535 (revocation), and 424.540 (deactivation of billing privileges).)

YesNo
[1.2a] If Yes: Please specify which policies and what modifications you recommend.
YesNo
[1.3a] If Yes: Please identify the specific requirements/policies and describe recommended alterations.
[1.4] What changes could CMS or its contractors make to existing processes to promote their ability to effectively deter fraud, waste, and abuse and promote payment accuracy and efficiency, including by more expeditiously gathering actionable information?
[1.5] What types of analytics, methodologies, or data-driven approaches would be most effective in identifying indicators of potential fraud, waste, or abuse? We welcome feedback on specific analytical techniques, models, technologies, mechanisms, or data sources that could strengthen our ability to proactively detect and prevent fraudulent activity.
[1.6] A core component of crushing fraud to protect taxpayer dollars is transparency to the Americans we serve about CMS’ program integrity undertakings. How can CMS improve its transparency about its oversight and enforcement activities?
[1.7] CMS currently does not have an affirmative, regulatory authority to direct Medicare Advantage (MA) organizations and Part D plan sponsors to suspend payments to providers and suppliers that operate exclusively in Part C or Part D or both. Should CMS establish regulatory requirements that allow MA organizations and Part D sponsors to implement payment suspensions under circumstances similar to the payment suspension authority that exists for Traditional Medicare under 42 CFR 405.371, and require suspensions when directed by CMS?

YesNo
[1.7a] If Yes: Please explain your position: Provide reasoning for your answer, including any concerns or conditions.

Section 3: Preclusion List and Medicare Advantage Enrollment Requirements
[3.1] What changes could CMS make to better effectuate the preclusion list to prevent Traditional Medicare-revoked providers and suppliers from continuing to bill MA plans?
YesNo
[3.2a] If No or Partially: Please describe the gaps or limitations and suggest improvements.
YesNo
[3.3a] Please explain: Provide reasoning for your answer, including any conditions or concerns.
YesNoUnsure
[3.4a] If Yes: Please identify which high-risk types should be prioritized.
[3.5] What operational, administrative, and financial impacts would a requirement to enroll in the Traditional Medicare program have on providers and suppliers that currently only bill MA plans?
YesNo
[3.6a] If Yes: Please describe the alternative mechanisms.

Section 4: Reducing Medicare Fraud related to Laboratory Tests Including Genetic Tests and Molecular Diagnostic Tests
[4.1] What new statutory or regulatory authorities would empower CMS to more effectively prevent, identify, and address fraud in lab tests, including genetic tests and molecular diagnostic tests?
[4.2] What types of tools, data analytics, and methods would assist CMS to increase program integrity related to lab tests, including genetic tests and molecular diagnostic tests?
[4.3] What prompted other payors and MA organizations to require registration in the MolDX program?
[4.4] What safeguards or challenges has the MolDX program provided to your organization regarding laboratory testing?

Section 5: Reducing Risks from Non-Participating Durable Medicare Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Suppliers in Medicare Advantage
[5.1] What changes would MA organizations need to make to existing processes to promote the ability to effectively deter fraud, waste, and abuse and promote payment accuracy for nonparticipating DMEPOS suppliers?
YesNo
[5.2a] If Yes: Please identify the specific requirements and describe recommended alterations.
[5.3] What types of analytics, methodologies, or data-driven approaches are most effective in identifying indicators of potential fraud, waste, or abuse for non-participating DMEPOS suppliers? We welcome feedback on specific analytical techniques, models, or data sources that could strengthen MA organizations' ability to proactively detect and prevent fraudulent activity.
YesNoConditionally
[5.4a] Please explain: Provide reasoning and any conditions for your answer.

Section 7: Artificial Intelligence in Medicare Advantage Coding Oversight and Hospital Billing
[7.1] What types of AI solutions (including commercial off-the-shelf (COTS) products) are most effective and efficient for assisting human coders with large volumes of records?
[7.2] What key features and learning capabilities should an AI solution include to improve accuracy, incorporate coder feedback, and prevent errors or "hallucinations"?
[7.3] How should AI-generated coding recommendations be displayed to human reviewers, and what compliance risks should be considered and mitigated?
[7.4] What lessons have been learned from implementing AI solutions, including pricing structures and use within cloud-based IT environments?
YesNoUnsure
[7.5a] If Yes: Please describe the solutions and their effectiveness.
[7.6] How could AI be used to increase the efficiency and accuracy of hospital billing?

Section 8: Beneficiary Solicitation
PhoneTextEmailMailSocial MediaIn-PersonOther
[8.1a] How do beneficiaries respond when they have been contacted by an inappropriate direct solicitation?
[8.2] If the prohibition on unsolicited contact via telephone by DMEPOS suppliers was expanded to other forms of communication, what obstacles would that create for DMEPOS suppliers that could hinder your ability to effectively serve Medicare beneficiaries?
[8.2a] In what ways could CMS mitigate those concerns while still expanding protections for beneficiaries?
YesNo
[8.3a] If Yes: Please identify the provider/supplier types that should be included.
[8.4] In what other ways should CMS expand the prohibition on unsolicited contact via telephone by DMEPOS suppliers? For example, should CMS explicitly prohibit DMEPOS suppliers from collaborating with marketing agencies or other third parties acting on their behalf to perform solicitation?

Section 10: Surety Bonds
[10.1] In accordance with section 1834(a)(16) of the Act (and as codified in 42 CFR 424.57(d)), DMEPOS suppliers are required to maintain a surety bond of at least $50,000 in order to enroll and maintain enrollment in Medicare. We request public feedback on means of strengthening our existing surety bond requirement. We are especially interested in suggestions on how CMS should use its surety bond authorities to be more effective in the fight against fraud, such as increasing the required bond amount, expanding the types of Medicare providers and suppliers that must maintain a surety bond, or taking tougher actions against bond companies that are not meeting their obligations when fraud is found. In addition, how can CMS strengthen surety bond requirements in Medicaid and CHIP, for example, with respect to Medicaid and CHIP home health providers?
Section 11: Medicaid and CHIP
Type a question
YesNo
[11.2a] If Yes: Please describe specific authorities and how they should be leveraged or expanded.
Yes - Every 4 YearsYes - Every 3 YearsYes - Every 2 YearsYes - AnnuallyNoOther
[11.4] What tools or technologies can CMS or states use to enhance program integrity in Medicaid, CHIP managed care, and fee-for-service programs?
[11.5] What tools or guidance can CMS give to states to enhance program integrity in the Medicaid and CHIP managed care and fee-for-service programs?
[11.6] What ways can CMS improve the prevention, identification, and resolution of fraud, waste, and abuse related to non-federal share financing sources, including intergovernmental transfers (IGT)?
[11.7] How can CMS better prevent, identify, and address Medicaid and CHIP fraud, waste, and abuse in the context of individuals who do not have satisfactory immigration status for full Medicaid or CHIP benefits who are accessing services inappropriately?
[11.8] How can CMS better prevent fraud, waste, and abuse associated with the differential payment of public and private providers?
[11.9] What data and information should states report to CMS to ensure that fraud, waste, and abuse is being identified, investigated, and resolved?
[11.10] What best practices and standardized processes should states implement when responding to recovery audit contractor (RAC) findings?
[11.12] How can CMS help states to better prevent, identify, and address Medicaid and CHIP fraud, waste, and abuse related to service areas that have been identified as high risk for fraud in certain states, such as the following: a) Housing stabilization services.
[11.12b] Behavioral health services.
[11.12c] Personal care assistant (PCA) services.
[11.12d] Nonemergency medical transportation.
[11.13] How can CMS further enhance the Healthcare Fraud Prevention Partnership (HFPP) to strengthen fraud detection within state agencies and law enforcement?
[11.14] What are the best practices for integrating artificial intelligence with existing technologies to maximize effectiveness?

Section 12: State-Specific Medicaid and CHIP Questions
[12.1] What statutory or regulatory changes are needed to strengthen states' ability to effectively reduce fraud, waste, and abuse in Medicaid and CHIP?
[12.2] What regulatory or administrative changes could CMS make to empower states to-- (a) pursue bad actors; and (b) better coordinate program integrity efforts with the federal government, law enforcement, and other states?
[12.3] What data or tools would facilitate state program integrity activities?
YesNo
[12.4a] If yes, please explain: Describe which databases would be most useful and how they would help.
[12.5] What successful strategies have certain states implemented that others can replicate as best practices?
[12.6] What is the best way for states to learn about the most up to date technology or data analytic tools available to effectively reduce fraud, waste, and abuse in Medicaid and CHIP?
[12.7] How can CMS help states better prevent, identify, and address fraud, waste, and abuse related to supplemental payments (for example, disproportionate share hospital (DSH) payments) or state directed payments?
[12.8] How can CMS help states better prevent, identify, and address fraud, waste, and abuse in section 1915 waiver programs or section 1115 demonstration programs?
[12.9] What incentives could be put in place for states to proactively engage in program integrity efforts, and what new penalties might be necessary to address non-compliance by states?

Section 13: Federally Facilitated Exchange (FFE) and State-Based Exchanges (SBEs)
[13.1] How could CMS strengthen program integrity, including fraud prevention and consumer protection, in both the FFE and SBEs by-- (1) better leveraging existing regulatory oversight authority; and (2) identifying areas where additional regulatory authority may be needed?
[13.2] How could CMS improve regulations to strengthen oversight of agents, brokers, web-brokers, and direct enrollment entities including compliance standards, training, and fraud prevention in both the FFE and SBEs?
[13.3] How could CMS expand its regulatory authority to incentivize insurance agencies to thoroughly vet assigned agents, brokers, and web-brokers assisting consumers with enrollment in FFE plans and hold agencies accountable for activities relating to these individuals?
[13.4] What specific measures could CMS implement to better curtail the ability of fraudulent agents, brokers, and web-brokers to enroll or change the enrollment of consumers without their knowledge or consent?
[13.6] How could CMS strengthen its standards for corrective action and for suspension or termination of agents', brokers', and web brokers' Exchange Agreements and what circumstances should trigger each type of action?
YesNo
[13.6b] If Yes, under what circumstances?
[13.7] How could CMS improve the accuracy, timeliness, fraud prevention, and any other aspects related to program integrity in income verification for FFE enrollees?
[13.8] What successful anti-fraud measures already implemented in SBEs should be adopted in the FFE and vice versa?
[13.9] How could CMS enhance HealthCare.gov to prevent fraud at the point of enrollment and reduce reliance on post-payment recovery (commonly referred to as "pay-and-chase"), and how could CMS most effectively encourage SBEs to adopt best practices for such fraud prevention within their legal and other authority?
[13.10] How could CMS expand its regulatory authority to enhance oversight of enhanced direct enrollment (EDE) partners?
[13.11] How could CMS expand its authority to monitor the activity of agents/brokers on EDE platforms?
[13.12] How could CMS better detect and mitigate improper dual enrollment in Medicaid/CHIP and subsidized Exchange plans?
[13.13] How could CMS leverage advanced technologies, such as AI, to prevent, detect, and address fraud, waste, and abuse in both the FFE and SBEs?
Should be Empty:

Section 1: Modifications to Program Integrity Requirements

Section 2: Enhanced Identity Proofing and Ownership Requirements

Section 3: Preclusion List and Medicare Advantage Enrollment Requirements

Section 4: Reducing Medicare Fraud related to Laboratory Tests Including Genetic Tests and Molecular Diagnostic Tests

Section 5: Reducing Risks from Non-Participating Durable Medicare Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Suppliers in Medicare Advantage

Section 6: Reducing Fraudulent Medicare Parts A and B (Traditional Medicare) Claim Submissions

Section 7: Artificial Intelligence in Medicare Advantage Coding Oversight and Hospital Billing

Section 8: Beneficiary Solicitation

Section 9: Beneficiary Contact

Section 10: Surety Bonds

Section 11: Medicaid and CHIP

Section 12: State-Specific Medicaid and CHIP Questions

Section 13: Federally Facilitated Exchange (FFE) and State-Based Exchanges (SBEs)