Dr. Mehmet Oz, speaking as CMS administrator, argues that Medicare and Medicaid fraud and waste are large enough that aggressive enforcement could materially extend the Medicare trust fund’s life, while also supporting a major industry effort to reduce prior authorization delays through digital data sharing. He frames prior auth as a patient frustration that can be streamlined without weakening necessary oversight.
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In this CNBC interview, CMS Administrator Dr. Mehmet Oz discusses two seemingly opposite healthcare moves: cracking down on fraud and abuse in Medicare/Medicaid while also making prior authorization easier and faster for legitimate care. He says prior authorization is the single issue that angers patients most, citing cases where a biopsy or other needed procedure can be delayed for weeks because insurers require extra approval. Oz argues that insurers and doctors should move from fax-based workflows to direct electronic data exchange through EMRs so authorization can happen immediately when eligibility is clear. He says the new industry coalition—described as 29 major healthcare companies—reflects a broader commitment from insurers to reduce prior authorization more than 10% in the last year and move toward real-time decisions. …
Near term, the actionable setup is in healthcare policy enforcement: providers tied to hospice, Medicaid services, or questionable billing may face audit and payment risk, while vendors that help automate prior auth and claims data exchange could benefit from reform momentum.
Over the next several weeks and months, the base case is a continued push toward faster prior auth alongside tougher fraud enforcement. The setup improves for firms that can prove clean claims, real-time data integration, and lower utilization friction; it worsens for businesses dependent on opaque billing or manual approval bottlenecks.
Structurally, the clip points to a more digitized and surveillance-heavy U.S. healthcare payment system. If CMS succeeds, the long-run regime is less about manual paperwork and more about algorithmic verification, with less room for abuse but also less tolerance for sloppy billing models.
Prior authorization is the single issue that angers patients more than anything.
Oz directly frames prior auth as the biggest patient frustration.
Industry has already cut prior authorization by more than 10% in the last year and is moving rapidly toward immediate decisions.
Oz says the industry is already making progress toward faster authorization.
CMS and insurers should move from fax-based authorization to direct digital exchange through electronic medical records.
He argues data should flow electronically rather than through fax back-and-forth.
Can't we make prior authorization more streamlined and faster using AI and modern technology?
Dr. Oz says prior authorization is the single issue that angers patients most. He describes the frustration of a patient needing a biopsy who is forced to wait six weeks. He explains that President Biden used the power to convene to get the insurance industry to fix this voluntarily. They've already cut down prior authorization by over 10% in the last year and are moving toward real-time authorization at the doctor's office by having insurance companies reach directly into electronic medical records.
Do you worry that people who actually need these services won't get them because of the fraud crackdown?
Dr. Oz says they don't want to hurt the people of Minnesota — they want to make sure people are paying attention.
Is there a trend underneath about who owns all these fraudulent hospice and medical equipment places?
Dr. Oz says yes — large organized criminal syndicates with foreign connections are involved, including Russian mafia in LA and Chinese mafia in Flushing, Queens. He notes that in South Florida, one third of all durable medical equipment suppliers are run by Cubans who flee back to Cuba when approached by law enforcement. The goal is to stop the money from leaving the building before it gets laundered overseas.
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