Washington, D.C. — Nursing home advocates are pleading with the federal government to slow down on its sweeping new fraud crackdown, warning the plan could pile fresh paperwork on operators already drowning in regulation.
The Centers for Medicare and Medicaid Services rolled out its Comprehensive Regulations to Uncover Suspicious Healthcare program — better known by its blunt acronym, CRUSH — in late February. The agency wants tighter screening for providers, artificial intelligence to flag suspicious claims, and shorter deadlines for filing them.
After the public comment period closed on March 30, two of the largest advocacy groups in long-term care fired back. Their message: don’t punish the providers who are doing things right.
“Padlocking the jar”
CMS Administrator Dr. Mehmet Oz didn’t mince words when he announced the program. “CMS is done trying to catch fraudsters with their hands in the cookie jar — instead, we’re padlocking the jar and letting them starve,” Oz said in February. The program traces back to a June 2025 directive from President Donald Trump that ordered federal agencies to wring fraud and waste out of Medicaid.
The goal is hard to argue with. The execution is where things get complicated.
Nursing homes say they’re already being watched
Jodi Eyigor, vice president of health policy at LeadingAge — the largest association of nonprofit nursing home and senior care providers — told industry sources that CRUSH risks duplicating oversight that already exists. Ownership transparency rules, she pointed out, have been on the books for years.
“If CMS applies lessons from its more aggressive fraud efforts in hospice and home health, then nursing homes could face increased oversight and compliance expectations, underscoring the need for targeted, well-calibrated enforcement,” Eyigor said in a statement.
The American Health Care Association and National Center for Assisted Living, which speaks for 15,100 long-term care providers, took a similar line. Most providers, AHCA argued, “are legitimately submitting appropriate claims and should not be subject to additional arbitrary burdensome pre- or post-pay audits.” The group wants AI-driven targeting of bad actors — not new background checks and fingerprint requirements layered on top of the existing audits already hitting 1,500 nursing homes.
The AI question
AHCA didn’t reject artificial intelligence outright. The group said it could help verify enrollment data and zero in on bad actors. But it pushed for a guardrail: human review.
Without that, AI-driven audits or claim denials could disproportionately hit nursing homes that serve patients with unusual or complex needs — facilities whose billing patterns might look like outliers simply because their residents are sicker.
“AI driven recommendations for audits or denials, whether pre- or post-pay, should have human oversight to assure that specialty providers or those with unique patient populations are not disproportionately targeted,” AHCA’s comment said.
What’s next
CMS hasn’t said when CRUSH’s final rules will land, but the agency cast a wide net for input — from states, providers, payers, tech companies, and patient advocates. For nursing homes, the worry isn’t the goal. It’s the price tag of getting there.
