Goodsurance

Policy & oversight

CMS Will Publish Medicare and Medicaid Billing Data in Open Format to Aid Public Fraud Oversight

A Federal Register notice dated July 23 announces that CMS will release Medicare and Medicaid program data in machine-readable, open-license formats to help the public, researchers, and watchdogs identify potential fraud, waste, and abuse.

By the Goodsurance editorial teamJuly 20, 2026

The Centers for Medicare and Medicaid Services published a notice in the Federal Register on July 23, 2026, announcing the forthcoming release of Medicare and Medicaid program data in open, machine-readable formats under an open license. The action is authorized under the Open, Public, Electronic, and Necessary Government Data Act, which requires federal agencies to make data assets available for free public use and analysis.

CMS stated that the data release is intended to support public engagement in identifying and preventing fraud, waste, and abuse in the Medicare and Medicaid programs, and to promote accountability and transparency. The agency noted it took steps to protect sensitive beneficiary information before publishing.

CMS will release Medicare and Medicaid billing data in open formats so the public and researchers can help identify fraud.

The announcement builds on existing data-sharing work at CMS's Data.CMS.gov portal, which already hosts Medicare payment and utilization information. The July 23 notice signals an intent to expand that catalog in formats designed for broader public use.

The move comes as federal attention to improper payments in Medicare remains high. A 2026 Government Accountability Office report, GAO-26-107799, found that CMS's data analytics tools helped prevent an estimated 11.9 billion dollars in potentially fraudulent Medicare payments across fiscal years 2022 through 2024. Advocates for data transparency have argued that wider public access to billing records can help surface potential fraud patterns that formal enforcement sometimes misses.

In plain words

On July 23, 2026, the federal government said it will share Medicare and Medicaid billing records with the public in formats that anyone can download and analyze. A law called the OPEN Government Data Act requires agencies to share data this way. CMS says the release will help people spot possible fraud and overcharging in Medicare and Medicaid. CMS also said it will protect personal health information before releasing anything. This adds to data CMS already shares on its website. A recent government report found that CMS's own data tools helped stop about 11.9 billion dollars in likely fraudulent payments between 2022 and 2024.

Source: Federal Register
Read at the source →

More news

Other stories on what is moving in Medicare.

Policy & oversight

CMS Barred a Puerto Rico Medicare Advantage Plan From Accepting New Members for 2027

The Centers for Medicare and Medicaid Services issued an enrollment suspension notice on September 3 prohibiting MMM Healthcare LLC from enrolling new Medicare Advantage beneficiaries under contract H7522 for contract year 2027. Existing members are not affected.

September 23, 2026

Policy & oversight

Missouri Receives More Than 45 Million Dollars in Federal Rural Health Grants for Hospitals, Behavioral Care, and EMS Training

Today's announcement directs funds to facility upgrades at 20 rural hospitals, psychiatric consultation access for children and families, and training for hundreds of emergency medical workers.

September 22, 2026

Policy & oversight

OIG Found About 2.3 Million Dollars in Medicare Telehealth Billing Violations That CMS Safeguards Did Not Catch

A federal audit found that Medicare paid for virtual check-ins and e-visits that violated billing timing rules because CMS and its contractors lacked automated detection tools.

September 21, 2026

Policy & oversight

New Mexico Receives 74 Million Dollars in Federal Rural Health Funds to Expand Specialty Care Across Frontier and Tribal Communities

Six Regional Hub Organizations will use the five-year grant to bring telehealth, e-consults, chronic disease management, and workforce support closer to rural, frontier, and Tribal residents statewide.

September 21, 2026

Policy & oversight

Traditional Medicare Required Prior Authorization for Certain Services in Six States for the First Time Starting January 2026, KFF Finds

A KFF examination of the WISeR Model, active in Arizona, New Jersey, Ohio, Oklahoma, Texas, and Washington, found it targets services whose spending grew about 400 percent between 2019 and 2024.

September 21, 2026

Policy & oversight

CMS Releases Final Mandatory Participant List for New Medicare Specialist Payment Model Starting January 2027

Cardiologists and certain pain, orthopedic, and neurosurgery specialists treating Medicare patients for heart failure or low back pain in selected areas are now on notice that a mandatory payment model ties their Part B reimbursement to outcomes beginning January 1.

September 20, 2026