Dr. Oz On Affordability, Fighting Fraud, and AI in Healthcare

- This is The Capitalism and Freedom in the 21st Century Podcast, an official podcast of the Hoover Institution's economic Policy working group where we talk about economics, markets, and public policy. I'm Jon Hartley, your host. Today I'm joined by Dr. Oz, who serves as the 17th administrator for the Centers for Medicare and Medicaid Services in the second Trump administration. He's a professor emeritus at New York Presbyterian, Columbia Medical Center and has won nine daytime Emmy awards with his long running daytime talk show, the Dr. Oz Show. I'm also joined by Dan Broman, who is the director of Medicaid and Chip and deputy administrator at CMS and Kim Brand, who is CM S'S Chief Operating Officer, as well as a deputy administrator. Thank you so much for, for joining us. Really an honor to have you all here. And I wanna start, I just really, you know, gotta tell you, you know, I think with most administrations, very few people have any idea sort of what CMS does, or they might not have heard of it, even though it's the largest single organization on the planet when it comes to actual dollars being spent. But now in the second Trump admin, I have to say, I, you know, you're sort of the talk of the town this go around and you built a, a really incredible team of clinicians, entrepreneurs, healthcare experts, and more that seem to be everywhere all the time. And you're working on a number of very, very highly impactful initiatives. Dr. A I wanna start with you. You were a very successful TV host. What inspired you to take on these exceptionally demanding roles at the service of the president? Well, thanks for the kind words. I've always been in the change business. And by that I mean, I, I, I love when there are issues we can do better at. And it's true in cardiac surgery, which was, that's been a good part of my adult life. I, I knew there were better ways of doing these without having to open someone's chest with a band saw, which seemed archaic. And turns out there are ways now we can change heart valves with catheters you put through vessels in the groin. I invented one of them, started companies that worked in that space. I learned a lot about how to organize people, but I also learned a lot about how take on entrenched interests, but also change people's minds. 'cause if you're gonna move from doing traditional surgery to a new version of that same procedure, you gotta get people to think differently about a solution set. That's one of the reasons I went into media. It wasn't my vision to, frankly, it wasn't on my vision board at all. My wife, Lisa, was the one who kept petitioning me saying that when I would come home and lament the fact that people I had operated on could have avoided my services, if they'd just been warm months earlier to change their lifestyle, it would've avoided them needing to have any of these operations. That got me thinking, well, maybe I should get the word out in a different way. And just to be, you know, blunt about it, the reason America doesn't get the message on health is sometimes is because we don't give it to them. And then at the same time, we made it hard to be healthy in America. And that translates into really expensive healthcare because we're sicker than the rest of the world. That's why we cost twice as much per capita as any other country in the world is because we're twice as obese. Statistically, we're 43% obese, and it's only about 20% in Europe, it's 5% in Japan. So president, you know, president Trump recognized that Secretary Kennedy, the Maha movement, embraced that idea, we can be healthier by being proactive. And so when the opportunity came to be able to serve in politics, one of the opportunities was to support lifestyle changes, but also use the money that drives and incentivizes behaviors in a, in a more efficient way. And the president in invited me into the administration relatively soon after the election. It was probably 10 days after we won. So I had the jabal, which is to be able to recruit people like Dan Broman and, and Kim Branch, who you'll gonna be hearing a lot from top tier individuals who could have served anywhere, anytime, or frankly were doing very well in the private sector. But getting them to come in and join in this, this effort and really generational opportunity to make a difference in how we think about healthcare, which will last for decades, is what's attracted so much talent in the government. And I have to admit, my, my biggest bias coming on your podcast and, you know, participating with the Hoover Institution on this, is to recruit people. You guys are listened to by really smart folks who wanna make a difference. So if any of you're out there are motivated, as you're driving your cars, wherever you're headed, think about driving to Washington and joining us. We need people, we're hiring a thousand more folks. And I'm very sincere when I say this is your opportunity to make a difference. Well, I'm very impressed by the amount of talent that you've been able to bring on. I mean, on top of Dan and Kim, Jeff Carlton, another deputy administrator I I know very well from some past jobs. And, you know, I'm very impressed just by the overall like, caliber of talent that you've been able to attract in CMS. It's very, I impressive. I wanna segue into affordability because that's a, a big topic right now. I know the, the Trump administration is doing a lot of things on, on affordability. America has been having a crisis of affordability when it comes to healthcare and families are sacrificing, say a lot of, you know, basic necessities like food and transportation in order to pay for rising healthcare costs. I mean, how did we get here over the many years and what are you doing about it at CMS? Well, we got here because we were all willing to allow friction in the healthcare system. And that friction starts in your home. The battle for health should be won in the kitchen, the living room, the bedroom. And if you make it hard to be healthy and you allow all kinds of changes to almost common sense regulations. Like for example, the original food pyramid, which was scandalous, you know, based on trials that were historically unlikely to be true, turned out they weren't. There was this honesty and how it was reporting, and I'll be very concrete, the, the, the vilification of dietary fat and cholesterol in favor of simple carbohydrates was criminal. And we have a bunch of people in America think you're better off having the white foods, white rice, white flour, white pasta, white sugar, as opposed to a little extra fat around the piece of high quality steak. And it turns out that, yeah, if you, if I have a choice and I do have a choice every day, I'd rather have the steak. Now there's lots of other ways of getting protein in your diet, but it's those kinds of decisions that have been made and and endorsed for a generation that allowed us to become sicker as a population, which has made it much more difficult and complicated to treat us. But we also have within the healthcare system, toll takers. And just again, for your audience, this is a pretty good example of how economic theory actually does coincide with reality. If you allow people to create friction in a system so data doesn't flow fluidly with, with there, there, there, there's data blocking. In fact, in many instances, institutions don't collaborate, insurers don't work with providers. You have electronic medical record systems that won't allow certain other people to get access to what they have as, as intel or insights. Everyone along that value chain where there's friction takes a little toll, just a, they dip their beak in the flow of information and money. And when you're talking about in our agency, $2 trillion coming through the spigot is a lot of opportunities for, you know, 10 billion here, 50 billion there, a hundred billion the other places. It soon adds up to some real money. So part of the opportunity within CMS is how to spend tax dollars, $2 billion of them wisely, is to try to take away some of that friction. And I think our biggest wins ultimately will be measured in how we're able to create a free flow of data that allows us to use technologies for, you know, AI could be a good example, but many others as well. But let me give you one concrete example, something we've done for affordability and then I wanna turn it over to, to Kim and talk about this A second big topic that's come up and, and Dan can, can chime in at this as well. So let's look at the, the concerns about pharmaceutical drug pricing. About 27% roughly of the American public when they go to a drugstore, leaves empty handed, even though they had a prescription from a doctor to pick up a medication that theoretically would've made their life better. And what most Americans don't realize, even though almost one in three walk out empty handed, is the part of the reason is they pay on average three times more for the exact same drug made in the same facility in America usually than European counterparts pay. So how's that possible? The global freeloading is, is a, is a unfortunate but real problem that's been able to persist for decades. President Trump did not want that, did not tolerate it was animated by frankly, in a way that you don't wanna disappoint him in. So we went out, Chris Klum participated in Hernandez, John Brooks, other members of the team that have that have joined us. And we went head to head with pharma and said, NOMAS, you've gotta come to us with drug prices that are, that are the same as what you're selling for in other countries. Now we're not price fixing you pick your price, but whatever you decide the price is, that's the price for everybody. You can't charge more for us so you can charge less elsewhere. And that is DR driven down prices. And you know, we'll save about $600 billion for America over the next 10 years thanks to these policies. And all these medications now are available on Trump rx.gov, which four out of five medications purchased in America are available on that site. So before you make a purchase, at least check the site to make sure that you're getting the best price available. You can even do it in the pharmacy before, before you pick up a medication. So that's just one obvious win. Another big win is fraud, waste and abuse. I'll just give you one number and then turn it to Kim to, to walk you through what we've been doing. If we could take the fraud out of Medicare, just Medicare, we would take the medi, the the, the trust fund that that finances Medicare and double its life expectancy. So if anybody's worried about whether there're gonna be enough money in a kitty when they're ready to retire, the answer is yes if you take the fraud out. And I'm not so sure if you don't take the fraud out. So Kim, tell 'em what they've won. Sure. So thanks Dr. Oz. So the issue is really simple here. Fraud in Medicare and Medicaid steals from the taxpayers, undermines trust and threatens care for the people who need it the most. So we've been very clear with our strategy, we've been aggressive, we've been data-driven and we've been nationwide. And because of that we've used smarter analytics, stronger oversight, tougher regulation, deeper law enforcement partnerships, improved data integrity, and a really kick butt workforce ready to combat modern fraud schemes. So we are not just committed to addressing fraud, we are crushing it, as we like to say at CMS. So let me touch on the scope and scale of the fraud and delve into our strategy. But before I do that, I wanna give you just a couple of additional numbers that Dr. Oz talked about. So let's talk about what we've done in terms of our fraud detection and detection and enforcement totals. So since we started the CMS war room in 2025, in March of last year, we have been able to stop over $2 billion in potentially fraudulent payments from going out the door. We have been able to have a return on investment of $49 billion stopped from going out the door in terms of avoided payments, recovered dollars, and overall impact on the program. That is a 59% increase over what it was the year before. We have also suspended almost 800 California home health and hospice providers just this year by leveraging AI driven data modeling. So these new tools, these new approaches, they're proving big dividends as Dr. Oz said. And our hope is that that is really going to impact the longevity of the trust fund and make sure that we are being better steward of taxpayer dollars. We have been looking at things like improper payments in high risk sectors, in durable medical equipment where we have over $2 billion in improper suspicious payments because of that. We've done a six month moratorium on DME, meaning we are not enrolling any new durable medical equipment suppliers into the program. If you look at just South Florida, just south Florida, not all of Florida, there are twice as many durable medical equipment suppliers there as there are McDonald's, which is just mind boggling when you think about it. We've also been looking at millions in Medicare payments that have been tied to billing for deceased patients or for services never rendered, which is a big problem that we continue to look at because one of the things you don't wanna do is pay for services for people who are no longer alive. Another problem we've had, particularly with hospice, is that people allegedly are never dying. So we have a huge increase in the number of people in hospice, which is raising elevated oversight concerns. So what we've done is we've taken our strategy, we used to be pay and chase, we for years, for 20 plus years, CMS has had to chase the money after it goes out the door. Well, we're now going to prevent and detect we wanna stop that money from going out the door. So we have completely changed how we are doing this using real-time analytics. The war room that I mentioned before that has come back with over $2 billion in results just since last March, has analysts, investigators and policy experts that are all working together to detect and disrupt fraud in real time. And the other part, and this is where it'll be a good segue to hand it over to Dean to talk about some of what we've been doing with the state has been strengthening our federal and state oversight. We have really been working with high risk states. You've seen a number of the states that we've been working on. Those are states that our data has shown us, Minnesota, California, New York, Florida, even now we've just been working with Ohio where there are issues, high issues with them, billing for personal care services, adult social daycares, hospice, home health. And we've been using our actions such as the moratorium for DME that I mentioned, as well as enacting a home health and hospice moratorium for six months. And then doing things like enhanced provider screening and prepayment reviews to prevent those bad actors from gaining or rebilling or regaining billing privileges. With that, I'm gonna hand it over to Dan to talk about what we've been doing with states like California and Minnesota and how we've been approaching it. Yeah, thanks Kim. And I wouldn't be able to do what I'm doing to lead the Medicaid program, which is almost a trillion dollars without Dr. Oz's leadership and, and Kim as well. You know, and I had a unique problem that is that we're solving, which is around, we have 50 different programs and they're all very, very specific state programs and you know, when the money goes out the door, they're running substantially running those programs and every dollar needs to go to the beneficiary who needs it the most. And we understand and see that that's not happening. You know, one of my pillars for our Medicaid program is how do we streamline the program's design and operations versus 50 different programs that are so different in nature? And as we get to fraud, I think about how to scale standardization across the Medicaid program so we're all doing the same thing in the same way. And that's not the case for fraud, waste and abuse. And so we're taking that approach to fraud. So all 50 states move to a proactive posture using data analytics that Kim has helped us with and taking proactive action. One of the things that the, the CMS has done is help states work on a revalidation across all their high risk providers. And so getting everyone to level up and say, okay, who are my high risk providers? I should be revalidating them on a more regular basis. We're providing them a couple years to be able to do that, but that levels everyone up together and doing it in the same way. That means we're all rowing in the same direction, the federal and state government with the same tools, the same posture. And so, and the second thing I wanna talk about is the progress that we made and going after fraud. These are unprecedented use cases like that she talked about in Minnesota where it's on TV every day. We had to act, you know, work with them, build a corrective action plan to make sure we we right ship that, that area. But we're normalizing that fraud, waste and abuse exists everywhere. I think that's gonna be important for the American people. Sometimes states would talk about, you know, I'm taking care of things on my own. They sometimes they knew what was going on but they couldn't get it done. Now we're normalizing it so that we all can take a step back and say, this is happening and what are we gonna do about it? And it's all our responsibility, the federal government and every state to ensure every dollar goes to those who need it the most. As Dr has says a lot to steal your benefits, to steal your health or steal your life. And so that's very meaningful to us. But most importantly, we don't wanna be doing this all day. We want states to have the right tools, the right data, the right programming. We're hosting demo days today for advanced analytics for all of the states around fraud, waste, and abuse. Kim has provided dashboards and analytics, so states for the first time can understand trends, anomalies, they can see what's actually happening in their state hotspot, compare themselves to other states as well, which is super important. You know, the way I think about it is, you know, if this was your house right and you were being robbed every single day and you're watching those robbers go by, you wouldn't wait months to take care of it, right? You'd take that very, very seriously and you, and you, you wouldn't do it slowly. You would use every tool at your disposal so it never happens again. And I hope the latter is obviously, you know, that's where we're going and we want every state to be able to take care of it in the same way for every taxpayer dollar. It's so great to hear about your strategy to root out waste, fraud, abuse nationwide. I mean, reflexively, you know, policy people talk about waste, fraud, abuse all the time, but it's always been very abstract and and I feel like now it's, it's becoming realer and I think a lot of what your efforts are are are, are helping to make it real and and, and making it easier to, to track down, you know, every day it seems like there's new media reports about, you know, billions of dollars of, you know, rampant waste, fraud abuse in the healthcare system. And we've heard and about some of these, you know, stories about, you know, fraudulent daycare and autism centers in min in Minnesota. Yes. Some of these hospice centers in California. I mean, and, and you know, that obviously that Nick Shirley video that came out I think in, you know, December, January was I think just a a a mass regulatory moment for a lot of people. I mean, what, I mean, what were you thinking when that video came out and you, you've been working on this task force with the vice president. How much did you think the, what do you think about the re response to that video? I, I feel like it was viewed millions of times, but I'm, I'm just curious like what, what, what was your reaction to it and and what do you think the, the broader reaction to that video, and obviously people, you know, being very upset, do, do you sort of see that very much as sort of a, a mandate to, to root out waste, fraud, abuse sort of now that people are, are increasingly more aware of it. But I feel like that was a, that was really a, the, the, the big shock wave that that woke up a lot of people to what was once sort of thought as an abstract thing to something that's very real. And for many people, you know, very close. Well the videos brought alive the egregious behavior of the criminals. They, they weren't scared we had come to accept fraud as part of how government works. And I have to say, COVID changed everything. There'd been fraud before COVID. But in healthcare fraud is such a a, a harmful endeavor that you're taking from people who are down and out and struggling. You're taking the last thing they have, which is support from their government, our fellow man. And you're stealing from them. And so when you see these guys driving off of Lamborghinis and refusing the talk and they're sort of ignoring and laughing at the law, so to speak, people get angry now, yes, the money matters. There's no question we think it's a hundred billion dollars a year that's slipping out of our fingers in government. And as Kim pointed out, you know, we, we wanna detect and prevent the money from going out anymore, they just, money should never leave the building that we're in right now, that's the safest place. 'cause once it leaves the building, these are criminal multinational organizations, they're often responsible. The real kingpin, the money leaves the country. It's hard to get back. We've caught people at the airport with, you know, gold, you know, bars in their suitcases. The number one airport for money leaving the country is Minneapolis. I mean, how is that possible? So it it, it had been so normalized that people thought, well it's gonna be corruption everywhere. So they steal from healthcare. So I think that was part of the wake up call. But, you know, we were a year ago approached by Minnesota, we had been pestering them for a couple months about what, you know, whether they had their arms around the fraud that was out there. And they finally came to us at a, at a meeting in, at the, towards the end of the summer and acknowledged they didn't have control over the fraud there. And they were desperately looking for ways to get their arms around it. And just as a concrete example, in Minnesota, as in many places in the country, they will pay to have you taken to the doctor's office, you don't have money. Now I could argue for that, you know, I'd rather you get your diabetes medication than sit at home with diabetes to develop renal failure than I have to pay for your dialysis. But in this, there's supposed to be, you know, how expensive could that be? They allocated a million dollars in the state of Minnesota to drive you to the doctor's office. When it went over a hundred million dollars, they realized they were outta control and they shut it down in Minnesota right now, if you wanna get a ride to the doctor's office, no one's taking you. The program's gone. What the president did by, with the working families tax cut legislation and the creation of the anti-fraud task force is save these programs because when the fraud gets bad enough, it all just go, boop, gone, finished nomas. And that's I think the bigger message that we started to appreciate these, these villains. And they really are unsympathetic characters are so audacious in their theft and so unrelenting in their desire to do evil and steal that it becomes a battle you wanna root for. We're at war with fraud. It's not just a financial issue where you've got numbers misplaced. But I wanna highlight it's not just about the the bad guys in fraud. The rules we have that govern these systems are so weak without guardrails, law enforcement can't help. And I wanna ask Dan to help you and the audience understand the challenges he faces. 'cause Dan is, you know, Dan just does brag on and built a very successful business helping folks who are, as Hubert Humphrey called them those living in the shadows and then sacrificed everything. He's got young kids come in the government and service, he's also in the Air force, by the way, is reserve. And so he's got to craft rules that all of us can agree on, make sense. And these are rules for who deserves to get care in some of these settings. But also he's gotta deal with things like the work requirement. Another sort of institutionalized fraud that we were facing where we said that again, the origins of Medicare, there it was 11 million people on the Medicaid program and you know, several times more that Medicare Medicaid's for poor people, Medicare is for older people. And so the original Medicaid program, you never thought about joining Medicaid if you could have, if you could work. And it wasn't for people who could work, it was for people who couldn't work for whatever reason. And so we gave in, in the, as part of the Obamacare changes, we allowed people to who, who are able bodied able to go out and participate in the workforce or some type of capacity to participate, the ability to just get free health insurance. So then I, I'd love if you can walk the audience through those two big issues. How do you make rules around fraud? But how do you, how do you tackle something like the work requirement that's you launched last week? Yeah, I mean these are great questions and you know, this is one of the reasons I'm here in this job and and working for this administration is this, it's a unique opportunity and time to define what Medicaid looks like for decades to come. And so, you know, a lot of these critical important programs, I had decades of experience working with health plans with Medicaid and Medicare, hundreds of hospitals, community-based organizations and governments across the board. And how technology is obviously a force multiplier to a lot of things that we're doing. And so, you know, a lot of the programs that are obviously well intended, you know, guardrails are, are critically important, but also the same guardrails across 50 states, right? And so aligning to how we streamline the programs design and operations, it gets so much more critical. And as we continue to spend almost $200 billion more as we grow the program, it's gonna be important that we have the right guard rails in place so that the people that need it the most are ensuring that we're getting and they're getting it. And that's gonna be the most critical. But if I take a step back, also, what we call the, the working families tax cut legislation, you know, it did three critical things which I think are super important for the future of, of Medicaid program and healthcare broadly. First is the Rural Health Transformation fund. I mean, this is $50 billion that is gonna transform rural health as the mass largest increase in investment in rural areas in a long time. And this is not supposed to be a short-term fix. This is about long-term sustainability plan to transform how we deliver care virtually using hub and spoke models, increase workforce care, different care models, access improvements, and most importantly, leveraging technology. We're not gonna, we can't add thousands of behavioral health specialists in rural areas. That's not possible. So we have to use the power of technology to drive access for as a, a force multiplier that that's truly game changing and states are already getting moving. And as a technology CEO in the past, I'm obviously helping them deeply on how to implement this and think about this for the long term as Dr. Oz talked about. The second biggest thing is our community engagement and work requirements. And I call it our promoting paths to prosperity. And there's really two critical things around this. This is not just about meeting requirements, it is to improve economic mobility. This is our opportunity to improve people's income for the population. And if every state had that goal in mind, which a lot of them do, this is going to have a huge impact on Americans, our economy, and ultimately people's wellbeing. They are better off, they feel better when they have more income and stable employment. They can buy nutritious food, they have more stable housing. And I've seen it firsthand. So many people are stuck in what we call this benefits cliff. They make a hundred dollars more. It's not worth it to lose all of these benefits, not just Medicaid. And so we're taking an approach, not just, just obviously meet requirements and this is a very big technology approach, that's why I'm here. But we're also taking the opportunity on how we can bring sectors together using technology to support that beneficiary. How do we connect them electronically to work opportunities, know what happened on the other side in a closed loop fashion? How do we bring community partners together around behavioral health and, and social services to lift them up. If people have barriers to work, let's close those barriers so we can all lift them up together to improve those beneficiaries lives. And the last thing I wanna talk about as it relates to the bill and, and the regulations that we're changing is the most important thing is Medicaid growth. The spending growth, obviously as Dr. Oz talked about, which is continue to grow, you know, outta control and we need to align spending and value the, the value we get for every dollar is, is critically important. And there's a lot of financing and, and eligibility transparency and accuracy changes that one closed loophole in how states were funding their portion of Medicaid and the results they were didn't increase or improve anyone's benefit. We have 75% of our population that has one chronic disease and 33% have three or more. So as we spent billions or hundreds of billions of dollars more a year, we weren't getting better. And when spending is increasing at a rate we can't afford, as Dr. Raj has also just mentioned, we can't add new programming that we know can help beneficiaries and are value oriented payment models because we simply can't afford it. So our goal is to really right size and align spending to the value that we get. Ensure our dollars are obviously focused on prevention, chronic disease, catch these issues upstream versus payment mechanisms that only benefit the supply side. Our obligation in the end is to two people, two groups. It's the taxpayers and the beneficiaries. And when we're implementing policies, which is why we appreciate those, these are our guiding principles of what is best for them. Yeah, it's, it's really great to hear about all these, you know, positive elements of, you know, working families, tax, tax legislation, the one big beautiful bills. It's commonly known as, we talk a lot about this on this podcast about, you know, the, a lot of the pro-growth elements of, of the tax bill. Often the, you know, corporate business side of things, business taxation side of things. And really it's so great to hear about all these, you know, pro-growth, you know, healthcare side of things that'll, you know, really have a positive impact on the healthcare industry and overall health of, of American citizens. Dr. Oz, I've got one last question for you. So you've spoken a lot about the transformative use of artificial intelligence in modern technology and healthcare. Tell us about what your vision is for how AI can best serve both patients and providers out there. I Think most folks listening now would agree that technology has been deflationary in most sectors of the US economy. That is not the case in healthcare. Quite the opposite. And perhaps that's because we use technology at the end of the care paradigm for the newest, coolest MRI scanner, you know, some new CRISPR therapy. And so if we don't use technology earlier in the course of managing the population, giving people access to care where they are meeting you, where you are to give you tips for prevention or actual treatment for, for conditions that maybe you otherwise would've ignored, then we're never gonna be able to make it deflationary in healthcare. We have that unique opportunity now because AI has progressed so rapidly if we use it correctly, it's a big question that it'll be massively helpful in keeping our population healthy. But as the pope spoke of in his icic, you, is AI going to serve humanity or will it bring us in the servitude? And I think that's the big wrestling match. So I'll challenge you, when was the last time you saw a movie where AI was the hero? It's been, it's been a while. That doesn't exist. I don't think I remember one. Yeah, It's a, it's always a like a dystopian post-apocalyptic world where that if only we had taken precautions. So we have to be able to use AI in a way that the American people feel comfortable. And there are some good use cases. I'll give you an example. Every single person and we cover over 160 million Americans. So we touch the lives of, you know, most, you know, half the people. And if, if you think about it, there's a couple things we give you that you should take like a free wellness exam for anyone over 65 on Medicare. Everyone gets it. It's free. Less than half the people take it. They claim that they're too healthy for it. In fact, by the way they claim that, but it's not true. We have the claims data, it turns out they're actually sicker than the people who get examined every year. So if we could make tools and we now have mechanism of attracting technology companies to work with us, we have a built a model where we'll pay you to make apps that make people healthier again, meet them at home and reduce your diabetic risk or your actual hypertension, whatever the issue is. These are remarkably effective. And so we, and under the Amy Gleason's leadership have been able to pull together over 700 tech companies. Every company you've ever heard of is a pledge pretty much to our CMS effort. They will agree to share data, improve the system, follow certain guide and participate in the digitalization of healthcare in America. Even our COBOL based, you know, 19 6 79 circa system is being upgraded finally. 'cause we don't have any engineers left to know that stuff. We didn't even have engineers, we had less than 10 engineers in the entire organization. Think of how scandalous that is. So Kim Brandt, she's Chief operating officer, she's not just a guru of of fraud. She actually worked with Amy Gleason. Both, both of them were angels and completely refigure how we treat data organizationally within CMS. I think this is a, a role model for how other organizations may think about bringing technology AI into the workflow. So do you wanna walk folks Kim, through what you were able to do? Sure. So we created a whole new office of healthcare technology and policy or products, I'm sorry, not policy products. And the new office is really intended to help us centralize and manage the creation of technology products and programs that traditionally, at least here at CMS have been managed separately across multiple offices and centers. We have over 35 offices and centers at CMS. So that's a lot of different places, a lot of different silos. And what was happening was people were creating things in those silos, but they weren't able to leverage the technology. They weren't able to leverage the people as Dr. Oz talked about with the engineers and others. And what we have been able to do by creating this new office, which just launched yesterday, is to create much greater consistency or we're hoping to create greater consistency around how those products are delivered across CMS. And it supports a lot of the goals that we're hoping to establish here at CMS for the last year and a half under Dr. Oz's leadership, we've been looking at driving, you know, better data practices across CMS, trying to do more shared services, trying to have more common platforms, having better interoperability. This new office is gonna help us accelerate those efforts in a really meaningful way. And what's exciting about this also is that this helps us to get better capabilities and better tools for our agency. One of the things that kind of is adjacent to this that, that Dr. Oz didn't mention is that we have been really pushing again with his leadership on the entire workforce at CMS, almost 6,000 people becoming conversant in ai. We have a chief economist, a new Milani, who is actually helping teach all of us on the senior team how to use all the AI tools and what they mean and how we can use them. And then we have 30 AI ambassadors that are then going out and teaching the 6,000 person workforce about these tools. So as we are not only creating better products and better things to help our beneficiaries, we're also training our workforce to use these tools to be able to make better policies and have things that are going to be more usable for those beneficiaries. Terrific. I I know Anu Milani, he's a terrific professor of economics at University of Chicago, so you're, you're very fortunate to have him and, and Dr. Oz, I couldn't agree with you more On, can I interrupt? Can I Absolutely interrupt one second since you're on Anoop. So Anoop has been running data, you should speak to probably worth a separate discussion of how the reduction of of government funding of healthcare that's inflationary. When we throw money at problems, it actually costs the commercial sector more money as well. And especially for your audience. It's not just a, you know, unfortunate reality that government will sometimes sloppily spend on programs that don't make sense. When we do that, we actually inflate prices in other sectors of the health economy and that's one of the reasons that we, I think are overpaying for healthcare. Now there are some things we're not paying enough for and Dan Broman made Kim, we came here to build, we didn't come here to cut, but you gotta take some of the fat out a scalpel, not a meat cleaver. And to do that effectively, Anup has been a big part of this. You actually wanna use the, our superpower, which is not legislation. I can go to Congress, which is across the street literally from me and ask for legislation. It doesn't always work out well. I can go make rules, they can be challenging as well. But the power to convene is our superpower. We can go to industry 'cause we're a payer, right? We're paying stuff all the time. So we have extra lever arms. So Dan Broman can go to the, all the major tech vendors that work in Medicaid and say, I need you to give us a discount. Or frankly just nothing for charges to get us off the ground on this work requirement. He spoke about then negotiated over $600 million in discounts for the states. Kim can do the same thing. She can have bakeoffs and competitions for vendors who wanna help us with fraud. We're doing the same thing with our call center negotiations. We're doing the same thing with the effort to digitize, you know, in a modern cloud-based way, the way the building system for our programs all negotiated because we have the power to convene. The greatest example though is prior authorization. Something is heinous process that know folks listening now don't like I know it 'cause statistically no one does, but it does work in redu. It's like a second opinion but forced on you and the insurance company stops you from getting something done that you want that's hard to fix with the law, the way you fix those kinds of problems. You tell the insurance companies, we're gonna come after you if you don't deal with this, but we know you don't like it either. It wastes your time, the doctor's time, patients hate it, fix it. And then we get the providers, the docs, hospitals to work together. There's actually a meeting upstairs I left to come do this podcast where they're speaking. And then the final part, of course you get the patients engaged. There's so many clever ideas, so many smart ways of fixing these problems. And they're nimble if industry participates. And if the one defining nature of this administration, I think is the president likes cutting deals, come work with us, offer us a better mousetrap to help us think through a challenge that we have tried to fix through government, you know, policy. Which again, we're trying to, we're trying to fix problems. Sometimes the best way to fix the problem is, you know, call the people who are involved in the problem and say, guys, you have a better idea than we do. If you do, we'll give you safe harbor. Go take care of the issue we're watching. If you don't do it, we're coming after you. But we have been remarkably gratified at how well this has worked. Well, it's really amazing to hear just yeah, about this, these fantastic efforts attracting so much talent, really bringing, I think a, an innovator's mindset to government. Also, you know, what you said earlier about on AI and echoing what Pope Leo, you know, said about how we should be, you know, AI should be serving us not the other way around. As he said, this recent cyclical. And really great to hear about all the efforts across the board from, you know, fighting, combating fraud with the, you know, anti-fraud task force. You know, the, the changes in the one big beautiful bill that are are related to healthcare and of course, you know, Trump, RX, what's going on, on the affordability front as well with the, some of the most favorite nation deals as well. Really wanna thank you all for coming on on the show here. It's been a really fantastic conversation and and honor to have you all on. God bless you. Take care. Thank you. Thank you, Jim. This is the Capitalism and Freedom and the 21st Century podcast and official podcast of the Hoover Institution's economic policy working group where you talk about economics, markets, and public policy. I'm John Harley, your host. Thank you so much for joining us.