Dozens of influential divisions within the Trump administration‘s Centers for Medicare & Medicaid Services are headed by holdovers from the Obama and Biden administrations, a Washington Examiner review has found.
Those officials could complicate the Trump administration’s stated plans to ramp up a crackdown on fraud in the Medicare and Medicaid systems.
A Washington Examiner review of public webpages found that roughly four dozen senior CMS staffers, including many at the director level, were first appointed to leadership positions under Democratic administrations, previously served in political roles for Democrats, or have worked at left-of-center advocacy organizations. The true number of such staffers is almost certainly higher, as not all public employees maintain online public accounts of their work history.
Trump announced a “war on fraud,” to be spearheaded by Vice President JD Vance, during his State of the Union address this week. Even before Trump’s address, the Trump administration had taken an aggressive posture specifically against fraud in the Medicare and Medicaid programs, releasing a flood of provider-level data intended to empower the public to spot unusual billing patterns and, potentially, fraud.
Still, critics on the Right have said the Trump administration has so far not done enough to root out fraud in taxpayer-funded programs like Medicaid.
Of particular interest to the Trump administration is that several top CMS staffers in key enrollment and oversight roles are holdovers from the administrations of President Barack Obama and President Joe Biden. These staffers include both the director and deputy director of CMS’s oversight group, as well as the director and deputy director of the agency’s Division of Enrollment Policy & Operations, which is responsible for developing policies, procedures, and oversight for its provider enrollment programs.
“There have been a couple of high-profile settlements related to the Medicare Advantage program in which the federal government alleged healthcare affiliates were pressuring doctors to fraudulently inflate the sicknesses of those enrolled in the program so those affiliates could get higher payouts from the federal government,” Sarah Lee, Capital Research Center’s communications director, told the Washington Examiner. “CMS enrolls people into that program, and despite enrollment numbers that were predicted to fall, Medicare Advantage has grown by about 1 million people as of February, even with the program’s recent troubles.”
“Which is to say, whoever is working at CMS should be serious about getting a handle on the enrollment numbers so that any potential fraud can be investigated,” Lee added. “Otherwise, it’s another slap in the face to the American taxpayer.”
Other divisions led by civil servants who attained leadership positions under Democratic presidents or otherwise worked for left-of-center employers include the agency’s divisions of performance-based policy, information technology, acquisitions and budget, data analytics, operations management, regulatory affairs, state demonstrations, communications, state-based initiatives, clinical standards, emergency preparedness, consumer support, contract administration, financial management systems, and program integrity.
Additionally, CMS employs a number of senior staffers in non-leadership positions with similar work histories across multiple divisions.
The Washington Examiner compared personal webpages against CMS’s organizational chart to confirm the employment status of agency leadership with links to Democratic administrations and organizations.
Civil servants sticking around between administrations, even when the party in the White House changes, is not historically unusual. Proponents of the civil service often point out the importance of preserving expertise across administrations such that the provision of government services is not hampered by the regular bleeding of institutional knowledge and technical expertise. Further, not every civil servant works on politically sensitive matters.
To that end, Trump issued an executive order during the first day of his second term seeking greater “accountability” for civil servants in “policy-influencing positions.” The order, which has faced legal challenges, gave the president authority to fire certain civil servants at will.
“In recent years, however, there have been numerous and well-documented cases of career Federal employees resisting and undermining the policies and directives of their executive leadership,” the executive order reads.
During the first Trump administration, there was widespread concern among conservatives that bureaucrats were actively hamstringing the president’s agenda. Some career government workers admitted to doing as much.
Proponents of this strategy often argue that bureaucrats serve as an important check on the president’s power, whereas critics characterize their behavior as undermining the will of the electorate.
The measures the Trump administration has announced thus far to combat fraud in Medicare and Medicaid could very well be subject to bureaucratic influence.
On Wednesday, for instance, CMS Administrator Mehmet Oz and Vance announced that the administration would be deferring $259.5 million of quarterly federal Medicaid funding in Minnesota pending an investigation into fraud claims, implementing a moratorium on Medicare enrollment for certain medical equipment suppliers, and initiating a broad regulatory push to assist in fraud prevention.
Regulations pushed in the past by Republicans have included attempts to restrict people or entities from vouching for their eligibility to receive taxpayer funds without any meaningful government effort to verify whether they are telling the truth. Oz has hinted that other states, such as Maine, may also be in the agency’s sights.
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The situation at CMS could harken back to an earlier period in the second Trump administration, where government workers worked internally to derail efforts pushed by the Department of Government Efficiency. The fallout from Trump’s early reform efforts underscores that combating alleged waste and fraud can be controversial among bureaucrats.
In some instances, the Trump administration has not been shy to fire top-level career staffers it views as out of step with its priorities. At least two top officials were removed from their posts at the IRS in 2025, according to the Daily Caller. Scores of employees fired under similar circumstances have sued the Trump administration, alleging wrongful termination.
CMS did not respond to a request for comment.