Ever since the Gov. Tim Walz (D-MN) Medicaid fraud scandal broke — when a handful of bad actors turned Medicaid into a fraud buffet while elected officials looked the other way — the Trump administration has been moving mountains to make sure it never happens again.
Weeks ago, Vice President JD Vance and White House deputy chief of staff Stephen Miller met with lawmakers on Capitol Hill to press Congress for tougher anti-fraud legislation covering Medicare and Medicaid, citing roughly $235 billion in suspected fraud across federal programs.
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Last month, the administration even took the remarkable step of deferring federal payments to Minnesota and California until they can resolve concerns over suspected theft from Medicaid. All of this is great news and hasn’t come a moment too soon.
But not every proposal on this front is created equal.
Some bureaucrats, looking to emulate the administrative priorities laid out by the Cabinet’s leadership, have inadvertently taken aim at one of the free-market innovations popularized by the Trump administration — one that is directly responsible for lowering healthcare costs.
The issue lies within the Centers for Medicare and Medicaid Services’s recent proposal to plug a fraud gap in remote patient monitoring — the technology that lets doctors track patients with chronic conditions from afar.
Remote patient monitoring is a great healthcare innovation. No longer do those with diabetes, hypertension, and other ailments have to wait for their next doctor’s appointment to be measured on a glucose monitor or blood pressure cuff. Instead, they measure this data themselves at home, which is then automatically transmitted to their physicians. This technology eases the burden on hospitals and taxpayer-funded programs like Medicare by cutting down on extended patient stays, dropping bed days by as much as 70%.
The first Trump administration saw the potential of RPM, significantly expanding its coverage under Medicare in 2019 as part of a larger push toward telehealth. That’s why the administration should now consider how CMS’s newly proposed anti-fraud rule will put these advances at risk.
Under the measure, RPM could no longer be administered by a private company; it must instead be overseen by a doctor’s office. The idea is to localize RPM care within established healthcare institutions and thus cut down on the potential for fraud. The problem is that many doctor’s offices don’t have that staff to spare. This is especially true in rural America, where 43 million people currently experience primary care shortages.
About 20% of people live in rural communities, but only 10% of physicians practice there. RPM helps close this healthcare gap by making sure patients can receive information and guidance at home without having to drive hours to the nearest doctor’s office or wait months for the next available appointment. The healthcare accessibility and affordability crises will only get worse if doctors can no longer contract with companies to handle RPM.
There’s no doubt that fraud exists inside Medicare. There’s also no doubt that a small handful of RPM companies have contributed to the problem, and these companies need to be held accountable. But there are ways to do this without undoing the progress President Donald Trump’s own administration set in motion in 2019 — whether that’s CMS banning the cold-calling of beneficiaries that’s fueled so much of the abuse, or requiring physicians to sign off on every RPM order before any patient is enrolled. These moves would single-handedly stop most of the foul play on their own.
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Doctors and patients shouldn’t have to pay because Walz looked the other way. This is a problem to be sorted out by the same law enforcement that’s bringing justice to the criminals in Minnesota — not doctor’s offices that are already struggling to spend enough time with patients.
The Trump administration is right to aggressively target the fraud that’s been robbing taxpayers blind for too long. Let’s just make sure the bureaucrats who are seeking to enforce all its priorities place the blame exactly where it belongs.
Peter St. Onge, Ph.D., is senior economist at the Heritage Foundation’s Thomas A. Roe Institute for Economic Policy Studies.