Published in RINewsToday on June 8, 2026
As skyrocketing Medicare fraud schemes cost taxpayers billions each year, congressional leaders, federal agencies, and consumer advocacy groups intensify their efforts to combat aggressive scams targeting older Americans.
Experts estimate that Medicare fraud, waste, and abuse may cost as much as $60 billion annually. However, no federal agency publishes a definitive total amount because much of the activity goes undetected.
The growing incidents of Medicare fraud, waste, and abuse framed the discussion on June 3, 2026, at the Leon Mathieu Senior Center in Pawtucket, where more than 40 older adults gathered for the Fifth Annual Medicare Fraud Prevention Week event.
During the 75-minute presentation, three federal officials shared valuable information with the attending Medicare beneficiaries, designed to increase their awareness of fraud tactics and equip them with practical strategies to safeguard their personal and health care benefits.
The afternoon program was hosted by Rhode Island’s Senior Medicare Patrol (SMP), along with special agents from the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG), the Centers for Medicare and Medicaid Services (CMS), and the City of Pawtucket.
At the gathering, municipal, state, and federal leaders warned that Medicare recipients remain primary targets of fraudsters who use fake medical claims and identity theft. Specific types of fraud were highlighted, including durable medical equipment (orthotic braces, urinary catheters), genetic testing, and fraudulent billing by medical providers.
Learning to Spot the Warning Signs
Christine Anderson, Health Information Manager at the Rhode Island Office of Healthy Aging (OHA) and the leader of the state’s SMP program, said the program’s goal is to provide beneficiaries with practical tools to protect themselves and encourage them to be more proactive in reporting suspicious fraud activity, potentially reducing the success rate of scams within Rhode Island.
Anderson emphasized that scammers will often pose as representatives of Medicare, Social Security, or local human services offices to obtain or confirm Medicare numbers, which can be used to bill for unnecessary durable medical equipment such as back or knee braces.
SMP’s Program Manager urged attendees to review their Medicare Summary Notices (for Original Medicare) or their Explanation of Medical Benefits (EOMB), and to seek assistance from the SMP program and the Leon Mathieu Senior Center (or their local senior center) if they see unfamiliar charges.
“If something doesn’t look right, ask questions,” Anderson urged.
“We are grateful to the OHA, HHS-OIG, CMS, and the SMP for bringing this important information directly to our residents,” Donald R. Grebien, Mayor of Pawtucket said. “Education and awareness are critical in protecting older adults and preserving the integrity of the Medicare system.” It is one of the strongest defenses against scams targeting older residents,’ he says. Grebien pointed out that fraud can threaten both the financial security and well-being of seniors.
Echoing Grebien’s sentiment, Elizabeth Moreira, Pawtucket’s Deputy Director of Administration, said community education is key, stressing that awareness of the growing prevalence of scams is one of our strongest tools for preventing fraud. “Events like today give our community and caregivers the tools they need to recognize warning signs, protect their personal information, and report fraud before it can harm them,” Moreira said.
Federal Enforcement Efforts
HHS-OIG Special Agent Victoria Mens and Assistant Special Agent Lindsay Walford described their federal agency’s role in investigating fraud, waste, and abuse across more than 100 HHS programs, including health, social, and Medicare and Medicaid programs.
The federal agents also explained how they fight Medicare fraud, waste, and abuse.
They highlighted how the Office of Audit Services and the Office of Evaluation and Inspections publish reports on systemic problems including nursing homes lacking emergency power and using antipsychotic drugs to control residents.
To safeguard $2 trillion in federal healthcare funds, HHS-OIG conducts audits, evaluations, and criminal investigations.
The federal officials also cited prosecutions involving overbilling for medical equipment, large-scale catheter fraud schemes, and psychiatric billing for services that were never provided.
One of the most costly schemes involving urinary catheters was estimated to have resulted in attempted losses of about $4.5 billion, notes Walford.
During the presentation, Walford cited a Rhode Island case. She noted that Zynex Medical allegedly overbilled multiple payers about $873 million for TENS units and excessive supplies, leading to criminal charges against company leaders and a non-prosecution agreement with the company.
“A lot of that has been stopped, and so that money hasn’t all gone out, but that’s the tune and counting as to how much they’re attempting to pull out of the Medicare Trust Fund,” Walford said. She gave an overview of HHS-OIG accomplishments. Between April and September 2025, OIG work led to $2.2 billion in recoveries through settlements and criminal restitution. The agency said it returns nearly $13 for every dollar spent on oversight.
During the same period, investigators completed more than 900 investigations and issued hundreds of recommendations to prevent improper payments, says Walford.
Protecting Yourself
Mens urged seniors to treat their Medicare number with the same care as a Social Security number. “Don’t give out that information,” she warns. “If someone calls claiming to be from Medicare or says they are your healthcare provider, hang up and call back using a number you know is legitimate,” she says.
“Scammers rely on urgency,” Mens said. “Take time to talk with a family member, Medicare representative, or healthcare professional before making any decisions,” she says.
Jennifer Syria, Regional Administrator for the Centers for Medicare & Medicaid Services, pointed out that beneficiaries play a critical role in preventing fraud. “When you review your statements and notice unfamiliar charges, you become a valuable investigator in preventing fraud,” Syria said.
Syria encouraged residents to report suspected fraud and have key details ready, including provider names, dates of service, payment amounts, and Medicare Summary Notices.
“If you suspect you are a victim of fraud, our trained staff can meet with you to help resolve the issue,” says Mary Lou Moran, Director of the Leon Mathieu Senior Center. If you need assistance, call 401-728-7582. Moran notes that protecting yourself comes down to three key actions: prevent, detect, and report.
For more details about Rhode Island’s Senior Medicare Patrol program, call (401) 1-888-884-8721.
Tag Archives for CMS
Pandemic Lessons: “Essential Caregivers Act” Can’t Wait. A Merciful, Bipartisan Bill for a Voiceless Population
Published in RINewsToday on January 19, 2026
As COVID-19 spread rapidly across the country in March 2020—entering nursing homes largely through community transmission and staff movement—the Centers for Medicare & Medicaid Services (CMS) issued guidance calling for nationwide visitor bans in nursing homes. These strict restrictions barred all visitors and non-essential health care personnel, with limited exceptions for hospice care.
According to March 29, 2025 article, “Changes in Federal and State Policies on Visitation Restrictions in Nursing Homes During the COVID-19 Pandemic,” published in the Journal of Applied Gerontology, 31 states enacted statewide indoor visitation bans through executive orders between March 9 and April 6, 2020, and the end dates were between 6/15/2020 and 3/24/2021. CMS would later relax its guidance, permitting indoor visitation when facilities reported no new COVID-19 cases for 14 days and community positivity rates were low.
Charlie Galligan, a licensed criminal defense investigator in Rhode Island, knows firsthand the toll those restrictions took. He and his wife, Kerry, provided daily care for his parents for 13 years—his father, Jack, who died from Alzheimer’s disease in 2022, and his mother, Audrey, who lives with a traumatic brain injury. Balancing work with caregiving became the catalyst that pushed Galligan to lobby Congress to prevent the prolonged and unnecessary isolation of nursing home residents during future pandemics, including advocating for policies that allow designated family caregivers to visit.
“Long-term care lockdowns continued well after humane safety measures were established and family caregivers had been vaccinated,” Galligan claimed, noting that countless residents died alone as a result. “Daughters were forced to say goodbye to mothers with Alzheimer’s over FaceTime—often staring at their phones as exhausted staff struggled to provide even minimal connection.”
A Legislative Effort Revisited
The initial legislative proposal—the Essential Caregivers Act (H.R. 3733)—was introduced in June 2021 to reaffirm and enforce the right of nursing home residents to receive visits from family and friends during declared emergencies. When that proposal stalled due to the absence of a Senate companion bill, a second attempt followed the next year with the introduction of S. 4280/ H.R. 8331. Political insiders say that these bills stalled due to the legislative process, timing, and competing priorities not because Congress rejected the process. Most recently, the Essential Caregivers Act of 2025 was reintroduced last month.
On Dec. 16, 2025, U.S. Senator Richard Blumenthal (D-CT) and U.S. Representative Claudia Tenney (R-NY) introduced bipartisan legislation in their respective chambers to prevent a repeat of the prolonged isolation and reduced care nursing home residents faced during the COVID-19 pandemic. U.S. Senator John Cornyn (R-TX) and U.S. Representative John B. Larson (D-CT) joined them in cosponsoring the Essential Caregivers Act.
The Senate bill, S. 3492, currently with seven cosponsors, was referred to the Senate Finance Committee. That same day, the companion measure, H.R. 6766, with 35 cosponsors, was introduced in the House and referred to the Ways and Means Committee and the Energy and Commerce Committee.
“Our movement to enact the Essential Caregivers Act is not led by professionals or lobbyists,” Galligan said. “We are simply a determined group of family caregivers—primarily brilliant, tenacious women from across the country, and one token guy from Rhode Island—who love our mothers and fathers and refuse to accept silence and separation as acceptable standards of care.”
Congressional Supporters Call for Passage
“During the COVID-19 pandemic, we experienced how dangerous and inhumane it is to isolate seniors and vulnerable patients from the people who care for them the most, say Rep. Tenney, in a statement announcing the introduction of the bill. “Families were locked out, residents declined rapidly, and farm to many suffered alone,” she said.
“The Essential Caregivers Act ensures that this never happens again,” says Rep. Tenney, noting that they are loved ones, not visitors. “They are caregivers, advocates, and lifelines. This bipartisan legislation protects dignity, safeguards patient rights, and makes sure compassion and comment sense guide our response during an future emergency,” she adds.
Sen. Blumenthal emphasized the bill’s bipartisan intent. “By allowing at least one designated essential caregiver to have safe, in-person access to their loved ones during an emergency, our legislation ensures that residents will never again face the devastating isolation experienced by so many during COVID-19,” he said.
Rhode Island Sen. Jack Reed, a cosponsor of the Senate bill, echoed that sentiment. “We want to keep people safe from germs, but we also want to keep them connected—because isolation can take a real toll on health,” Reed said. “Essential Caregivers Act would ensure that even during limited visitation, residents can still have in-person contact with a loved one.”
Sen. Sheldon Whitehouse has expressed support and is on a waiting list to cosponsor it – cosponsors are being added in bipartisan pairs. “Loneliness can take a real toll on residents of long-term care facilities,” he said. “This legislation recognizes the critical role loved ones play in supporting residents’ well-being, even during public health emergencies.”
Not yet committed to cosponsoring are Rhode Island’s two Representatives
At press time, Rep. Gabe Amo, had not yet committed to cosponsoring the bill. “I am reviewing the Essential Caregivers Act of 2025,” Amo said. “Family caregivers are the backbone of our long-term care system, and I remain committed to advancing policies that support patients, caregivers, families, and health care providers.”
Like his House colleague, Rep. Seth Magaziner (D-RI), has not yet committed to sponsoring the bill. Magaziner acknowledges the importance of allowing nursing home residents access to their loved ones and is open to considering the legislation. However, he is also working to understand what safeguards would be in place to ensure resident safety during emergencies, according to Noah Boucher, the lawmaker’s communications director.
The Nuts and Bolts
Recognizing that family members are essential to residents’ care and well-being, S. 3492 and H.R. 6766 aim to prevent the emotional, psychological, and physical harm caused by prolonged separation during public health emergencies. This bill strikes a balance protecting public health while safeguarding the wellness of residents.
The Essential Caregivers Act requires nursing facilities receiving Medicare or Medicaid funding to participate. It guarantees that at least one designated essential caregiver may access a resident during periods of restricted visitation, provided the caregiver follows the same safety protocols as facility staff. If a resident is unable to designate a caregiver, a representative may do so on the resident’s behalf.
The legislation also affirms caregivers’ rights to advocate for residents, participate in care planning, and ensure residents’ civil rights are protected. Additional provisions address roommate rights, as well as exemptions for end-of-life and compassionate care.
Facilities must provide written justification if caregiver access is denied, with appeals overseen by state survey agencies.
The bill has been endorsed by the AARP and Consumer Voice.
Rhode Island Advocates Call for Passage
Calling for passage of the legislation, Rhode Island Long-Term Care Ombudsman Lori Light said the COVID-19 pandemic made painfully clear how critical family caregivers are to residents’ health, safety, and well-being.
“During extended lockdowns, we witnessed firsthand the profound impact isolation had on residents, including increased depression, anxiety, cognitive decline, weight loss, and loss of engagement in daily life. For many residents, family members are not simply visitors—they are essential partners in care – they provide emotional support, help residents communicate their needs, notice subtle changes in medical conditions, and advocate when something doesn’t seem right. When access was cut off, residents lost a vital layer of protection and connection. The lessons we learned during COVID-19 must guide future policy decisions,” Light said. “No resident should ever again experience prolonged isolation from the people who know them best,” said Light.
According to Deb Burton, MS, executive director of RI Elder, the isolation imposed on long-term care residents during the pandemic was devastating. While infection control was essential, she said, the complete separation of residents from their families caused profound and lasting harm. Burton, a gerontologist, noted that residents experienced rapid physical, cognitive, and emotional decline.
“Families endured anguish knowing their loved ones were frightened, confused, and alone during the most vulnerable moments of their lives. Family members are not simply visitors—they truly are essential caregivers. They provide a familiar face, a steady hand to hold, and an understanding of a resident’s routines, preferences, and communication needs. This is especially true for individuals living with dementia or other forms of memory loss, for whom familiarity and connection are critical to well-being and safety,” Burton said.
Comments from the American Health Care Association
While expressing support for family involvement, the nursing home industry has raised concerns about certain provisions of the bill.
From Holly Harmon, senior vice president of quality, regulatory, and clinical services at the American Health Care Association: “While we wholeheartedly support family members taking an active role in their loved one’s care, there are certain provisions of this bill where we have concerns. Mainly, we believe each situation, including public health emergencies, requires a collaborative process among public health officials and stakeholders to determine the most appropriate way to keep residents safe and loved ones connected, rather than implementing a blanket, inflexible process for all situations. We hope to work with lawmakers to make improvements to these proposals as the engagement of loved ones is critical to our residents’ wellbeing.
“Despite our caregivers doing everything they could to step in for family members during the pandemic, we were deeply concerned about the prolonged isolation of our residents. Public health officials were put between a rock and a hard place on how to best protect those in long term care, and due to the vicious nature of the virus on our resident population, it was determined best to restrict visitors and social interactions. Nursing homes were required to follow these restrictions until March 2021, and even then, CMS and CDC had strict guidelines due to the ongoing spread of the virus.
“The best way to prevent this global tragedy again is for officials to prioritize long term care residents and staff during public health emergencies, so that they can remain protected, active, and engaged with their loved ones and the community.”
A Final Note…
The best way to prevent another tragedy is to prioritize long-term care residents and staff during public health emergencies, so they can remain protected, active, and connected to loved ones. We must learn from the painful lessons of COVID-19. No one should be forced to decline alone, grieve alone, or die alone because of a lack of clear policy, RIElder’s Burton added. She noted that the Essential Caregivers Act ensures that in the next public health emergency” when it could be any one of us in a facility” we will not be separated from the person who knows us best and stands ready to advocate for us.
Caregiver Galligan remains hopeful. “This is simply a merciful bill for a voiceless population”, he said.
(updated 1-21-26)
Medicare Drug Savings Eclipsed by Part B Premiums, COLA Challenges and ACA’s Rising Costs
Published in RINewsToday on January 5, 2026
The official arrival of the New Year was marked by millions of viewers channel surfing between ABC, CBS, NBC, and CNN, eager to watch the ball drop in Times Square and ring in 2026. The iconic New York City ball—12,000 pounds and adorned with 5,280 Waterford Crystal discs and LED lights—descended a 139-foot flagpole atop One Times Square. In just 60 seconds, it reached the bottom at midnight on New Year’s Eve, signaling the beginning of 2026.
Just two days before January 1—when Medicare-negotiated prices for 10 prescription drugs take effect—AARP Executive Vice President and Chief Advocacy & Engagement Officer, Nancy LeaMond, shared good news. As the clock struck midnight, she announced that older Americans would see lower prices for the first 10 Medicare-negotiated drugs, which would take effect on January 1, 2026. AARP quickly issued a statement, celebrating the first-ever Medicare-negotiated drug prices and estimating a whopping 50% reduction in out-of-pocket costs for beneficiaries.
“For millions of older Americans managing chronic conditions, prescription drugs are not optional—they are a lifeline. But medicine doesn’t work if people can’t afford it,” said LeaMond in a Dec. 29 statement. She emphasized that AARP has been at the forefront of advocating for drug pricing reforms since 2022. The nation’s largest aging advocacy group, representing nearly 38 million members, shared their stories, conducted national research on drug costs, and urged lawmakers on both sides of the aisle to support legislative efforts to lower drug costs.
According to LeaMond, this advocacy has delivered significant progress. On January 1, negotiated prices will take effect for the first time, marking a major milestone for both patients and taxpayers. “Older Americans will see real results and billions in savings as the first Medicare-negotiated prices take effect,” she stated, pledging that “AARP won’t stop fighting to lower drug prices until every American can get the medications they need at a price they can afford.”
“These drugs are used by nearly 9 million Medicare beneficiaries and treat conditions such as diabetes, heart disease, autoimmune disorders, and cancer,” she noted.
While Medicare beneficiaries are set to see substantial savings, the Centers for Medicare and Medicaid Services (CMS) anticipates that the Medicare drug price negotiation program will save billions. CMS, a federal agency providing health coverage to over 160 million people through Medicare, Medicaid, the Children’s Health Insurance Program, and the Marketplace, expects the program to save enrollees roughly $1.5 billion in out-of-pocket costs in 2026 while saving the Medicare program $6 billion per year. The negotiated prices are a minimum of 38% off the 2023 list price.
On the Other Hand
Though Medicare beneficiaries will benefit from lower out-of-pocket costs on 10 Medicare-negotiated drugs in the new year, the 2026 Social Security COLAs will barely cover Medicare Part B premiums and rising inflation. Meanwhile, older Americans who are not eligible for Medicare coverage will face soaring health insurance premiums due to the Senate’s failure to extend the Affordable Care Act (ACA) Tax Credits.
Max Richtman, President and CEO of the National Committee to Preserve Social Security & Medicare, stressed the importance of ACA marketplace coverage for older adults, who often struggle to find affordable health insurance. “It’s not only cruel to let their premiums skyrocket; it costs everyone in the long run,” observes Richtman. “Older patients without insurance will be forced to use emergency rooms for care, which drives up costs for all healthcare consumers,” he says in a statement released on Dec. 11, 2026.
“They’ll also arrive at Medicare sicker or more disabled, which not only costs taxpayers more but raises premiums for all older Americans on Medicare,” warns Richtman.
Richtman pointed out that 40% of ACA enrollees are between the ages of 45 and 64. Without the extended tax credits, many of these individuals—including farmers, ranchers, entrepreneurs, and small business owners—will face unaffordable premium increases and may be forced to drop or downgrade their health care coverage. “Extending these tax credits to prevent premium hikes would have made simple common sense,” Richtman argued. “Why would Senators vote to push people off health insurance instead of widening the safety net when the ACA is so clearly beneficial, especially for older, vulnerable enrollees?,” he asked.
Additionally, this year’s premium increase for the standard Medicare Part B program, while not as high as originally projected, will still affect beneficiaries, too. They will face an increase of nearly $18 per month, marking roughly a 10% hike in 2026. In a statement on Nov. 17, 2025, Richtman said that this rise basically cancels out one-third of the average beneficiary’s cost-of-living adjustment (COLA) for 2026.
The standard Part B premium for 2026 will be $ 202.90 a month, which is $17.90 more than last year’s $ 186. The average COLA will be $ 56 a month in 2026. After accounting for the $18 Part B premium increase, the average Social Security beneficiary will be left with an effective monthly increase of only $36 next year, notes Richtman.
Richtman pointed out that the 2.8% COLA for 2026, announced in October, was already modest before the Medicare premium hike. “In this economy, an extra $36 per month will provide only marginal relief for Social Security beneficiaries,” he said, stressing that seniors with below-average benefits will see even less of a benefit increase once Medicare Part B premiums are deducted.
“Some in lower-income brackets may experience an effective COLA of zero,” predicts Richtman.
A Final Note…
Yes, Medicare beneficiaries will see a decrease in Medicare-negotiated prices for 10 prescription drugs that took effect last week. But, with inflation rising and older adults struggling to afford basic needs such as food, rent, utilities, and healthcare costs, aging advocates urge Congress to take action to mitigate the negative impacts of HR 1, the 2025 budget reconciliation bill, on the Medicare drug price negotiation program. It’s also crucial that Social Security COLAs accurately reflect the out-of-pocket expenses faced by beneficiaries, they say.
“Unfortunately, the 2025 budget reconciliation bill—HR 1—further limits the drugs that can be negotiated under the IRA’s negotiation program, reducing its effectiveness,” warns Julie Carter of the Medicare Rights Center in an October 9, 2025, blog post for Medicare Watch. “KFF, an independent health policy and research organization, estimates that this change will increase Medicare spending by at least $5 billion. As always, increases in Medicare spending lead to higher out-of-pocket costs for beneficiaries,” she says.
“At Medicare Rights, we strongly oppose efforts to scale back the IRA’s negotiation framework. We believe more drugs should be subject to negotiation, not fewer. We also advocate for expanding other cost-saving aspects of the law to reduce expenses for those covered by other forms of insurance,” Carter adds.
“Social Security COLAs are meant to offset the impact of inflation on beneficiaries. However, they are clearly insufficient for many seniors living on fixed incomes,” argues NCPSSM’s Richtman. He explains that this is why his organization has been pushing for an improved COLA formula—the CPI-E (Consumer Price Index for the Elderly). The CPI-E would more accurately reflect the inflationary effects on the goods and services seniors rely on, he says.
“We support legislation that would adopt the CPI-E for determining COLAs, but Congress has yet to take action. Adopting this formula would be a reasonable step toward expanding benefits and truly meeting the needs of 21st-century seniors,” Richtman concludes.
Herb Weiss 