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What CMS leaders said
On April 20, CMS Administrator Mehmet Oz and Deputy Administrator Dan Brillman, who directs Medicaid and CHIP, spoke with Sanford Health CEO and AHA chair-elect Bill Gassen at the start of the AHA Annual Membership Meeting in Washington.
- Waste: Oz estimated that about 5% of the CMS budget, roughly $100 billion, is lost to fraud, waste and abuse, and both officials said cutting unnecessary spending is a priority.
- Prior authorization: Oz said the agency is focused this year on working with insurers to reduce the need for prior authorization.
- Medicaid work rules: Brillman described community engagement standards that will require most Medicaid enrollees to complete set hours of work or volunteering to keep coverage, calling them a path to greater prosperity.
- Rural transformation: Oz described the $50 billion, five-year Rural Health Transformation Program as a testing ground whose lessons could benefit urban systems too.
Reading the signals
The message on waste cuts both ways for hospitals. A strong anti-fraud focus means more audits, data reviews and payment edits that will touch hospital claims. At the same time, the push on prior authorization gives hospitals an opening to document how insurer delays and denials add cost without adding value.
Medicaid work requirements are a direct financial risk. When people lose coverage because they cannot document hours or miss paperwork deadlines, many still come to the hospital, often sicker and without coverage. Systems with large Medicaid populations should assume some coverage loss and plan for it.
Inside the meeting, AHA leaders set their own agenda. President and CEO Rick Pollack named three priorities: improving community health, cutting regulatory burden and administrative waste, and advancing value through care transformation. Hospital leaders visiting Congress this week were asked to press for protecting access, advancing affordability solutions and strengthening the workforce.
What to do next
- Audit-proof key areas: Review documentation and coding in high-scrutiny services before regulators do.
- Quantify payer waste: Track prior authorization volume, delays and overturned denials by plan to support advocacy.
- Prepare for Medicaid churn: Fund enrollment and financial counseling staff to help patients document work and keep coverage.
- Join the affordability debate: Bring local evidence of how your system lowers costs to meetings with lawmakers.
Archive entry for Apr 20, 2026, added Nov. 11, 2026.