Congressional Leaders Urge CMS to Shield ACOs and Seniors from Fraud, Waste, and Abuse, Backing MyCare's $30 Million Battle

LUTZ, Fla., Nov. 19, 2025 /PRNewswire/ -- MyCare Medical, a participant in the CMS Accountable Care Organization Realizing Equity, Access, and Community Health (ACO REACH) Model, expressed strong support for a Congressional letter led by Ways and Means Health Subcommittee Chairman Vern Buchanan (R-FL), Congresswoman Claudia Tenney (R-NY), and Congressman Gregory F. Murphy, M.D., (R-NC). The letter urges CMS Administrator Mehmet Oz, M.D., to address the growing financial impact of fraud, waste, and abuse on ACOs.

Sent November 17, 2025, the letter highlights how ACOs face increasing exposure to improper billing from non-ACO providers – particularly involving wound dressings, skin substitutes, catheters, and other durable medical equipment (DME). Congressional leaders are asking CMS to exclude documented fraud or improper claims from ACO financial calculations and strengthen fraud, waste and abuse capabilities, including revisiting its significant, anomalous, and suspect criteria, within Medicare shared savings programs to protect seniors and safeguard taxpayer dollars.

Since 2022, MyCare has absorbed more than $30 million in improper DME claims attributed to its beneficiaries, largely tied to "pop-up" DME companies. More than 90% of these claims lacked evidence of a provider visit, patient receipt, or proper authorization. Many represent "phantom services" – items neither ordered by a licensed clinician nor received by the listed Medicare beneficiary – often stemming from identity theft schemes targeting seniors.

"I never received the items charged to my Medicare number, and I didn't know this was happening until MyCare informed me," Frank Adamson, a MyCare patient, said. "If this continues, Medicare may not be able to pay for my doctor visits. Thank you, Chairman Buchanan, for advocating for seniors like me."

"We applaud Chairman Buchanan and Representatives Tenney and Murphy for their leadership in protecting Medicare's integrity," Raj Shrestha, CEO of MyCare, said. "Unchecked fraud, waste and abuse erodes shared savings and undermines participation in innovative models like ACO REACH. CMS action is essential to ensure ACOs can continue providing high-quality, cost-effective care to more than 40,000 Medicare beneficiaries across Florida and Texas."

Launched in 2023, the ACO REACH Model strengthens care coordination, improves outcomes, and promotes health equity. In 2024, Medicare ACO programs achieved more than $2.4 billion in savings.

Unchecked Medicare fraud, waste and abuse imposes undue financial penalties on ACOs, hindering patient care investments and discourage providers from value-based demonstrations like the ACO REACH Model. MyCare urges CMS to approve pending reconciliation adjustments and implement broader protections to combat fraud, waste, and abuse across Medicare.

About MyCare Medical

MyCare Medical provides coordinated, value-based care to more than 70,400 patients across Florida and Texas, including high-acuity seniors, with a focus on equity, outcomes, and cost-effectiveness, supported by approximately 100 providers and 500 employees.

Contact

Shelbie Bynum
[email protected]
813-377-4884

The statements in this document are those of the authors and do not reflect the views or policies of CMS. The authors assume responsibility for the accuracy of the information in this document.

SOURCE MyCare Medical