I Submitted a Public Comment to CMS on the CRUSH RFI — Here's the Full Text

Context

On February 25, 2026, CMS published a Request for Information titled Comprehensive Regulations to Uncover Suspicious Healthcare (CRUSH). The RFI sits under docket CMS-2026-0826, file code CMS-6098-NC, published at 91 FR 9803. It asked the public for input on how CMS can move from reactive fraud recovery to proactive fraud detection across Medicare and Medicaid. The comment window closed on March 30, 2026. 768 comments were submitted.

I submitted one of them, as a practicing psychiatric-mental health nurse practitioner (MS, RN, CNS, AGACNP-BC, PMHNP-BC) and founder of DataLink Clinical LLC (SAM.gov registered), drawing on the data platform that powers OversightReports.com — covering all 14,713 Medicare-certified skilled nursing facilities and the 18 federal source categories behind them. The comment is on the federal record. I am publishing it here because public comments shape regulation and because the numbers inside it matter.

Tracking ID: mnd-wwib-9uji

View the full docket on Regulations.gov

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Full Text of the Public Comment

Request for Information: Comprehensive Regulations to Uncover Suspicious Healthcare (CRUSH)

Docket No. CMS-2026-0826 | File Code: CMS-6098-NC | 91 FR 9803

Submitted by: Robert Benard, MS, RN, CNS, AGACNP-BC, PMHNP-BC
Organization: DataLink Clinical LLC / OversightReports.com
SAM.gov: Registered
Date: March 30, 2026
Platform: www.oversightreports.com

I submit these comments as a practicing psychiatric-mental health nurse practitioner (MS, RN, CNS, AGACNP-BC, PMHNP-BC) and founder of DataLink Clinical LLC, registered on SAM.gov. I operate OversightReports.com, a publicly accessible, facility-level intelligence platform covering all 14,713 Medicare-certified skilled nursing facilities in the United States, built from 18 federal databases and updated through March 2026. My comments address Section II.A (Program Integrity Analytics) and Section II.B (Ownership Requirements).

Platform Data Sources: CMS Quality Measures | Payroll-Based Journal (PBJ) Staffing | Health Inspection Citations | Civil Money Penalties | HCRIS Cost Reports (Worksheet A-8) | CMS Provider Information Ownership Files

SECTION II.A — Program Integrity Analytics

1. Zero-RN Days Are Measurable From Existing PBJ Data and Represent a Legally and Clinically Significant Signal

Federal law requires at least 8 consecutive hours of registered nurse coverage per day in Medicare-certified SNFs (42 CFR 483.35(b)). OversightReports.com displays the percentage of days each facility reported zero RN hours, derived directly from CMS Payroll-Based Journal records, along with a discrepancy flag when self-reported hours do not match auditable payroll records.

This matters clinically as well as administratively. In SNF settings, registered nurses hold a distinct scope of practice from licensed vocational or practical nurses, particularly with respect to clinical assessment, care plan oversight, and evaluation of complex medication decisions. As a practicing psychiatric NP, I can attest that zero-RN shifts create conditions in which the clinical oversight required to appropriately evaluate PRN psychotropic medication orders may not be consistently present.

Citation: OIG Report OEI-04-22-00550 (June 2025) — CMS Use of Staffing Data to Inform State Oversight of Nursing Homes. CMS did not concur with OIG recommendation to flag RN staffing violations using PBJ data, citing resource constraints.
https://oig.hhs.gov/reports/all/2025/cms-use-of-staffing-data-to-inform-state-oversight-of-nursing-homes/

2. Antipsychotic Prescribing Rates (CMS Quality Measure 481) Reflect a Documented Measurement Gap That CMS Itself Has Quantified

OversightReports.com displays facility-level antipsychotic prescribing rates for all 14,713 SNFs. As of January 2026, CMS updated the Long-Stay Antipsychotic Quality Measure methodology to incorporate Medicare and Medicaid claims data in addition to MDS data. CMS stated in its official QSO-25-20-NH memo (June 2025) that the national rate under the prior measure was 14.64%, and that under the updated measure incorporating claims data this rises to 16.98%, because the prior measure did not capture antipsychotic prescribing outside the 7-day MDS look-back window.

This gap represents residents whose antipsychotic use was not captured in the official quality measure. CMS also confirmed that the updated measure will use additional data to validate schizophrenia diagnosis exclusions, directly addressing the pattern the OIG identified in its March 2026 report: that some facilities have applied schizophrenia diagnoses in ways inconsistent with residents' Medicare claims history in order to reduce their reported antipsychotic rate.

As a practicing psychiatric NP with prescribing authority, I can offer clinical context: schizophrenia has defined diagnostic criteria, and a facility-level schizophrenia diagnosis rate unsupported by corresponding Medicare claims warrants clinical review. This type of assessment is relevant to the legal defensibility of enforcement actions.

Citations:
CMS QSO-25-20-NH Memo (June 2025): https://www.cms.gov/files/document/qso-25-20-nh-revised-2025-09-10.pdf
OIG Report (March 2026) — Nursing Homes Inappropriately Diagnosed Residents with Schizophrenia: https://oig.hhs.gov/reports/all/2026/nursing-homes-inappropriately-diagnosed-residents-with-schizophrenia-to-mask-the-misuse-of-antipsychotic-drugs/

3. Related-Party Transactions Are Disclosed in CMS Cost Reports but Not Systematically Monitored at Scale

OversightReports.com displays related-party transaction dollar amounts from CMS HCRIS Cost Reports (Worksheet A-8) for each facility. These disclosures show payments from facilities to commonly-owned management companies, therapy vendors, and real estate entities. Systematic monitoring of these figures at the chain level would surface patterns currently invisible in claims-level analysis alone.

SECTION II.B — Ownership Requirements

OversightReports.com maps ownership and chain relationships for all 14,713 Medicare-certified SNFs, displaying operator name, number of facilities per chain, chain-average CMS star ratings, and chain-average civil money penalties. Chain-level patterns are entirely invisible when facilities are examined individually, which is why beneficial ownership disclosure at the 5% threshold matters for fraud detection.

I support enhanced ownership disclosure requirements for interests of 5% or greater, in machine-readable format, updated at least annually. Current public data does not consistently expose beneficial ownership structures, making it difficult to identify systemic patterns spanning multiple facilities under common control.

I appreciate the opportunity to provide input and support CMS's program integrity objectives.

Respectfully submitted,

Robert Benard, MS, RN, CNS, AGACNP-BC, PMHNP-BC
Founder, DataLink Clinical LLC
www.oversightreports.com
March 30, 2026

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Why This Matters

The three signals I raised in the comment — zero-RN days, antipsychotic prescribing gaps, and related-party transactions — share one common feature: CMS already has the data. It is collected, validated, and in some cases already published. What is missing is systematic monitoring at scale and the translation of raw data into signals that inform enforcement action.

For context on the scale of the related-party transaction issue specifically: across the 13,324 Medicare-certified SNFs for which HCRIS Worksheet A-8 data is available on OversightReports.com, aggregate related-party payments total approximately $11.26 billion per reporting year. This is not hidden money. It is disclosed on federal cost reports every year. It is simply not being monitored at the chain level, where the patterns would become visible.

The same is true for zero-RN days: the Payroll-Based Journal dataset captures this facility by facility, every quarter. The OIG told CMS in June 2025 that PBJ data should be used to flag RN staffing violations. CMS declined, citing resource constraints. The data is there.

And the same is true for the antipsychotic prescribing gap: CMS itself quantified the measurement gap (14.64% → 16.98%) and acknowledged that the prior measure missed real prescribing. The OIG in March 2026 documented the schizophrenia diagnosis pattern that closes the loop.

The CRUSH initiative is framed around uncovering suspicious healthcare. The three analytics I proposed do not require new data collection. They require using what CMS already has, more consistently, at scale, with clinical interpretation where it matters.

Public comments shape regulation. If CMS convenes Technical Expert Panels during CRUSH rulemaking, commenters are drawn from the public record. This is how the rules get made.

The full PDF of the submission is available on Regulations.gov under tracking ID mnd-wwib-9uji.