blase, brian paragon
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an 6 25 does he know he is lying/wrong? prolly
“One out of every $5 or $6 in Medicaid [payments] is improper.”
Russell Vought stated on June 1, 2025, in an interview on CNN’s “State of the Union.”
Responding to charges that President Donald Trump’s tax and spending bill would cut Medicaid coverage for millions of Americans, Trump administration officials misleadingly counter that it targets only waste, fraud, and abuse.
During an interview on CNN’s “State of the Union,” Russell Vought, the administration’s director of the Office of Management and Budget, framed Medicaid as sagging under the weight of improper payments.
An “improper” payment refers to payments made erroneously to beneficiaries and their providers or without sufficient documentation.
Pressed June 1 by CNN host Dana Bash about concerns that low-income Americans would suffer if the bill becomes law, Vought called such arguments “totally ridiculous.”
“This bill will preserve and protect the programs, the social safety net, but it will make it much more commonsense,” Vought said. “Look, one out of every $5 or $6 in Medicaid [payments] is improper.”
That would mean Medicaid’s improper payment rate is 16% to 20%.
In a 2024 report covering the years 2022, 2023, and 2024, Medicaid’s parent agency — the Centers for Medicare & Medicaid Services — said the rate was about 5.1%.
One conservative group, the Paragon Health Institute, said the agency has been using an incomplete calculation method and that the percentage could be as high as 25%. Other experts told PolitiFact that the actual numbers could be higher than what the federal government reports, although not as high as Paragon’s estimate.
The White House did not respond to an inquiry for this article.
How High Is the Medicaid Improper Payment Rate?
Medicaid and its closely related Children’s Health Insurance program provides health care and long-term care to roughly 83 million lower-income beneficiaries, accounting for about one-fifth of health care spending overall. It is funded through a mix of federal and state money and is administered by states under federal government rules.
Every year, the Centers for Medicare & Medicaid Services publishes official numbers for the share of improper Medicaid payments, and in other federal health insurance programs the agency oversees.
In a 2024 review of payments made in 2022, 2023, and 2024, the agency found that 5.09% of Medicaid payments totaling $31.10 billion were improper.
The 5.09% rate represented a decrease from the 8.58% rate cited in its 2023 report, which was also based on a three-year time span. The 2024 figure represented the third consecutive annual decline.
Are These Numbers Complete?
In March 2025, Brian Blase, a conservative health policy analyst and president of Paragon Health, a health policy think tank, co-authored a report that said the official CMS improper payment rate figures were unrealistically low for eight of the past 10 years, because in some years the agency failed to undergo widespread auditing of its beneficiaries’ Medicaid eligibility.
From 2017 to 2019, during Trump’s first term, Blase served as Trump’s special assistant for economic policy. Before that, he served as a health policy analyst for the Senate Republican Policy Committee and has worked for the Heritage Foundation, a conservative think tank.
The report said if the agency’s analysis had looked at eligibility checks every year, more ineligible beneficiaries and payments on their behalf would have been discovered. The report said this might have increased the improper payment rate as high as 25%, based on the rates found in 2020 and 2021, when a high number of eligibility checks were included in the agency’s methodology.
However, it’s hard to confirm whether lack of eligibility auditing caused higher improper payment rates in 2020 and 2021, said Jennifer Wagner, director of Medicaid eligibility and enrollment at the Center on Budget and Policy Priorities, a liberal think tank.
Wagner said Medicaid enrollment procedures have fluctuated, which could help explain the higher rates in some years rather than others. Using two years of data to generalize about trends across a decade, she said, is not necessarily valid.
Robert Westbrooks, the federal Pandemic Response Accountability Committee executive director who worked in government oversight roles during Democratic and Republican administrations, told PolitiFact it’s plausible that the officially reported improper payment rates for Medicaid could be too low.
However, Westbrooks said pinpointing how much higher the rate is in reality is a speculative process. “I don’t believe anyone can credibly quantify the [difference],” he said.
What Is an Improper Payment?
Health care experts emphasized that improper payments are not the same thing as waste, fraud, or abuse.
CMS maintains official definitions for these terms:
- Fraud: “When someone knowingly deceives, conceals, or misrepresents to obtain money or property from any health care benefit program.”
- Waste: “Overusing services or other practices that directly or indirectly result in unnecessary costs to any health care benefit program. Examples of waste are conducting excessive office visits, prescribing more medications than necessary, and ordering excessive laboratory tests.”
- Abuse: “When health care providers or suppliers perform actions that directly or indirectly result in unnecessary costs to any health care benefit program,” which can include overbilling or misusing billing codes.
By contrast, an improper payment “includes any payment to an ineligible recipient, any payment for an ineligible good or service, any duplicate payment, any payment for a good or service not received, and any payment that does not account for credit for applicable discounts,” KFF, a health information nonprofit that includes KFF Health News, wrote this year.
“Although all fraudulent payments are improper, not all improper payments are fraudulent,” said Jessica Tillipman, associate dean for government procurement law at George Washington University’s law school. “Most providers identify the improper payments and return them knowing how aggressively enforced” the legal provisions are. “When they don’t, they open the door to significant liability.”
CMS said about 79% of improper payments happened when there was insufficient documentation.
This typically involved cases in which a state or provider missed an administrative step, and it did not necessarily indicate fraud or abuse, the agency said. Instead, it could be an accidental oversight or mistake.
In other words, it was rare for ordinary beneficiaries to be scamming the government. “The vast majority of fraud in Medicaid is committed by providers or other actors, not enrollees,” Wagner said.
Our Ruling
Vought said that “one out of every $5 or $6 in Medicaid [payments] is improper.”
The official improper payment rate calculated by the Centers for Medicare & Medicaid Services in 2024 was about 5%, smaller than the 16% to 20% rate Vought described.
A health policy analyst and former Trump adviser said methodological shortcomings in the agency’s analysis could mean the rate is as high as 25%. Although it’s possible the rate is higher than the 5% the government reported, how much higher is speculative.
The statement contains an element of truth but ignores critical facts, namely the federal government’s own data. We rate the statement Mostly False.
Our Sources...
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an 5 25
Trump is urging the small Republican majorities in Congress to pass a "big, beautiful bill" that will combine his legislative priorities — and he is hoping they will do it sooner rather than later. But GOP lawmakers are fighting over the specifics, including possible Medicaid cuts.
A group of House Republicans in swing districts are declaring that they won't vote for any Medicaid cuts, which some budget hawks in the House Freedom Caucus are pushing for. Now, far-right conspiracy theorist Laura Loomer is weighing in on the Medicaid debate, and The Bulwark's Jonathan Cohn believes she may have an impact on this "fight for MAGA's soul."
In a Monday, May 5 post on X, formerly Twitter, Loomer wrote, "President Trump has repeatedly vowed to safeguard Medicaid, a promise that resonates with millions of hardworking Americans. Yet, so-called Republicans cozying up to this anti-Trump operative Brian Blase are risking it all…. Blasé's insidious push to eliminate provider taxes would gut Medicaid funding, hitting Americans the hardest in rural red states like Texas, Florida, and Louisiana."
Cohn, in an article published by the conservative Bulwark on May 6, notes that "the internal Republican fight over potential Medicaid cuts has gotten so intense that even Laura Loomer is getting involved."
Loomer is a very controversial figure in U.S. politics. Her attacks on then-Vice President Kamala Harris during the 2024 presidential race, critics say, were so racist that even far-right Rep. Marjorie Taylor Greene (R-Georgia) was offended.
But Trump likes Loomer — which, Cohn notes in his article, means a lot in the MAGA movement.
"On Monday night," Cohn explains, "the MAGA influencer known for white nationalist rhetoric and conspiracy theories posted more than 400 words on X defending Medicaid, the government insurance program that pays medical bills for more than 70 million mostly low-income Americans. Medicaid's future has been a topic of debate for months, with Republican leaders in Congress proposing reductions to the program to offset the cost of tax cuts Trump wants to pass in his 'big, beautiful bill'…. In prior times, Loomer’s opinions would not carry much weight with congressional Republicans, especially on social welfare programs. But she's proven influential over the past few months, including when she evidently persuaded Trump to fire a half dozen National Security Council staffers last month."
READ MORE:'Muted for being a jerk': This Trump official seems obsessed with fighting online critics
Cohn continues, "And her decision to warn lawmakers against Medicaid cuts wasn't just an attempt to distill and explain Trumpism's appeal to voters. It was also a direct attack on a particular strand of conservative intellectualism — and a particular conservative intellectual named Brian Blase, who, as president of the right-wing Paragon Health Institute, has been making the case for big Medicaid cuts for years. In the tweet, Loomer called Blase a 'RINO Saboteur' and 'covert Never-Trumper masquerading as a MAGA loyalist.'"
READ MORE:Why a far-right activist even condemned by Marjorie Taylor Greene has influence with Trump
*Jonathan Cohn's full article for The Bulwark is available at this link.
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AN 525 COMM DR
A letter that a group of 20 far-right House Republicans released earlier this week as part of a campaign in support of slashing Medicaid appears to have been authored by the head of a research institute with ties to the Koch network.
Politicoreported Friday that "digital metadata embedded in a PDF copy" of the letter that was circulated inside the House of Representatives "lists the author as Brian Blase, president of Paragon Health Institute."
InfluenceWatch notes that in 2021, Paragon received a nearly $2 million donation from Stand Together, "a right-libertarian funding organization that acts as the umbrella organization for the political network that is largely funded by right-leaning businessman and political donor Charles Koch."
Paragon recently urged federal policymakers to require states to conduct more frequent eligibility checks for Medicaid recipients in a purported effort to root out improper payments. Health policy advocates say such a change would make it more difficult for eligible enrollees to keep their Medicaid coverage.
The letter signed by Rep. Chip Roy (R-Texas) and other House Republicans aligns with Paragon's objectives, claiming that "political abuse" of Medicaid "is helping to bankrupt the federal government" and calling for "structural Medicaid reform" in the party's forthcoming reconciliation package.
Tony Carrk, executive director of the watchdog group Accountable.US, said in a statement that "you'd be hard pressed to find a more shameless example of congressional Republicans taking their cues from special interests at the cost of the American people than Chip Roy copying and pasting a letter directly from... special interests."
"This remarkably blatant kowtowing to conservative billionaires is a sad reflection of the congressional Republicans' willingness to make devastating cuts to Americans' healthcare to pay for lower taxes for the richest," said Carrk.
The letter was released as congressional Republicans grappled internally with how and how much to cut Medicaid as they seek to offset the massive projected costs of another round of tax breaks for the rich.
Earlier this week, as Common Dreamsreported, Rep. Don Bacon (R-Neb.) said he would not accept more than $500 billion in cuts to Medicaid over the next decade. Cuts of that magnitude would still be the largest in the program's history and would strip health coverage from tens of millions of people.
ref
A letter signed by 20 hard-line House Republicans calling for deep cuts to Medicaid in the GOP’s domestic policy megabill appears to be written at least in part by a conservative think tank with ties to top Republican leaders.
Rep. Chip Roy of Texas led the letter and promoted it publicly but digital metadata embedded in a PDF copy circulated inside the House and obtained by POLITICO lists the author as Brian Blase, president of Paragon Health Institute.
Blase served on the White House National Economic Council during President Donald Trump’s first term. He and other conservative health wonks launched Paragon in 2021, and it has rapidly gained influence in GOP policy circles. Former Paragon staffers are now top health aides to Speaker Mike Johnson and President Donald Trump.
According to tax records gathered by InfluenceWatch, Paragon has received seven-figure donations from groups linked to high-profile conservative activists Charles Koch and Leonard Leo.
The push from Roy and his fellow hard-liners to enact massive “structural” reforms across Medicaid comes as centrists and even some more conservative-leaning members have raised concerns about cutting too deeply into the program. Trump is also wary of slashing the program but has signaled he supports some efforts to curb spending.
The letter urges House Republicans to pursue “meaningful” reforms to the safety-net health program: “If the House budget reconciliation package does not include structural Medicaid reform that achieves desired Republican outcomes, we will be setting up massive tax increases and benefit cuts in the future,” Roy & Co. wrote. “For once, Congress should stop procrastinating, using excuses, and finally fulfill the Republican agenda.”
Asked if Blase was in fact the document’s author, Paragon spokesperson Anthony Wojtkowiak said in a statement that the group “sent a list of Medicaid reform principles to policymakers.”
“It appears that the excellent letter by Chip Roy and colleagues incorporated some of our ideas,” Wojtkowiak said, noting the group frequently works with lawmakers on policy issues.
A Roy spokesperson did not respond to a request for comment.
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