In a candid interview on Yahoo Finance’s Decoding Retirement podcast, Dr. Mehmet Oz—now head of the Centers for Medicare & Medicaid Services (CMS)—outlined sweeping efforts to reform a strained U.S. healthcare system, citing everything from rising Medicare costs and Medicaid work requirements to aggressive fraud crackdowns and digital innovation.
Overseeing coverage for more than 140 million Americans across Medicare, Medicaid, CHIP, and ACA health plans, Oz spoke frankly about the challenges ahead.
Tackling Medicaid Work Requirements
The recently passed One Big Beautiful Bill Act (OBBBA) is poised to significantly reshape Medicaid. According to the Congressional Budget Office, the law’s new work requirement—mandating 80 hours per month of employment, education, or community service—could slash federal Medicaid spending by $793 billion and reduce enrollment by 10.9 million by 2034.
While critics cite examples from Georgia where people have lost coverage due to bureaucratic hurdles, Oz emphasized tech-driven solutions as a fix. “We’ve already launched two pilots in Louisiana and Arizona with good results so far,” he said.
“The people running it are the same folks who fixed the passport system in America,” Oz added. The new system uses a smartphone app to verify hours worked via payroll providers. “Ninety-one percent of people on Medicaid have smartphones… You say yes and boom … the entire process is less than seven minutes.”
Still, Oz didn’t directly address how many might lose coverage before these digital tools are fully rolled out or how long it would take for nationwide implementation.
Medicare Advantage Under Scrutiny
Oz also took aim at alleged abuses in the Medicare Advantage program, where over 33 million seniors are enrolled. UnitedHealth and other providers are under investigation for inflating patient diagnoses—a practice known as “upcoding”—to receive higher reimbursements.
“In Medicare Advantage, I do think that there’s been an ability for the private companies to game the coding system,” Oz said. “That got them more money.”
To curb this, CMS is launching audits under the RADV process. “We expect it will be billions and billions of dollars,” Oz said. “But more importantly, we’re sending a message to the industry… I want you to thrive, but not at the expense of the American taxpayer.”
Medicare’s Fiscal Future
Rising costs are also a major concern. According to the 2025 Trustees Report, Medicare Part B premiums are set to jump 11.6% in 2026—marking the steepest hike in nearly 10 years. Meanwhile, the Medicare Hospital Insurance Trust Fund for Part A could be insolvent by 2033.
Oz called the looming premium spike a “major concern,” attributing it largely to skyrocketing drug prices. “There are other things… that we believe we have control over,” he said, suggesting that greater industry collaboration—not just regulation—may offer solutions.
“The… Trustees Report predicts that [Part A] is bankrupt in 2033,” Oz added. “In their worst-case scenario, it goes bankrupt in [2029].”
Open Enrollment and Consumer Guidance
As open enrollment for 2026 coverage nears (starting Oct. 15), Oz encouraged seniors to stay informed.
“We have to give people information,” he said. “Do your homework, but don’t feel pressured to change plans unless you have a clear reason.” He also plugged 1-800-MEDICARE as a key resource.
Hospice Fraud and Enforcement Crackdowns
Oz sounded alarms over a disturbing rise in hospice scams, where fraudsters sign up patients—often unknowingly—for hospice care. “This is a reprehensible activity,” he said. “It’s run by criminal syndicates… We’re going after them in a big way.”
In response to broader fraud threats, Oz declared a tougher federal stance. “We already have actions in several states… There is a new sheriff in town,” he said. “If you’re cheating the American people, we will come after you.”
The agency is working to modernize fraud prevention using better digital ID systems and data controls. “You’re talking about an agency with a $1.7 trillion budget,” Oz said. “We have to get it right.”
In closing, he echoed the mission that once made his TV show a household name: “The goal is the same as it was… Explain it so people understand it and can act on it.”
Pump Radar
Stock Alerts