Much has been written about CRUSH in the past month, here are two more.
American Journal of Managed Care covers Medicare fraud hearings. From Giuliana Grossi, April 24.
See also an essay at the consultancy ADVI, Stacey Gilbert, March 17.
The two articles frame Medicare fraud as both an immediate enforcement crisis and a future policy-risk issue for molecular labs. The AJMC article summarizes an April 2026 House Ways and Means hearing where witnesses argued that Medicare’s “pay-and-chase” design enables fraudulent providers to enroll easily, bill rapidly, and evade front-end scrutiny. Hospice fraud was a major example, including sham sites and patients improperly enrolled in hospice, with real clinical harm.
Witnesses urged stronger provider vetting, license verification, beneficiary claim notices, AI analytics, and better data-sharing.
The ADVI article focuses on CMS’s proposed CRUSH framework, emphasizing that it is not yet a rule or enforcement program, but an RFI exploring future oversight. It links CMS concern to rising 2024 Part B lab spending, especially genetic and molecular tests, and warns labs to prepare for scrutiny of utilization patterns, medical necessity, panels, reflex testing, and referral relationships
