A Trump-aligned legal group founded by White House aide Stephen Miller filed Freedom of Information Act requests Thursday targeting a Biden organ transplant program that critics warn could be open to abuse.
The requests from America First Legal went to the Department of Health and Human Services, the Centers for Medicare & Medicaid Services, and the Health Resources and Services Administration. At issue is the Increasing Organ Transplant Access Model, a six-year mandatory program finalized in December 2024 and set to take effect in July 2025, which aims to expand access to kidney transplants but has drawn criticism from Trump officials who warn it may be vulnerable to outside influence.
The model builds on earlier payment experiments, testing whether financial rewards and penalties can improve care and expand access for Medicare and Medicaid patients.
Trump officials and allies, including America First Legal, argue the system risks distortion by outside interests — a charge that prompted AFL’s FOIA requests as part of a broader investigation.
They cited in part recent findings from an HRSA-led probe published earlier this year. That investigation suggested third-party groups or for-profit organizations ‘may have unduly influenced the IOTA Model’— though their exact role or the extent they may have done so is unclear.
HHS Secretary Robert F. Kennedy Jr. also cited concerns from the study, which the department said in a statement ‘revealed clear negligence and disturbing practices’ by a large organ procurement organization in the U.S., prompting him to launch a new reform initiative.
In previewing the FOIA requests to Fox News Digital, AFL cited related concerns about patient safety, ethical misconduct, and discrimination in organ allocation, among other things.
The requests ask HHS, CMS and HRSA for a long list of information regarding the program and related correspondence — including emails, letters and memos between agency personnel and third-party representatives about the development or implementation of the IOTA Model. They also seek meeting records, agendas and summaries of discussions involving agency staff and outside officials.
The payment model will affect more than 100 U.S. transplant hospitals over six years, imposing mandatory financial incentives and penalties tied to a final performance score.
IOTA was touted as a way to help increase access to organ donors and transplants in the U.S. and help address the long waiting list of patients awaiting a transplant, which as of last fall stood at roughly 90,000 people.
Participating hospitals are evaluated for their performance in three key areas, according to CMS’s final rule, which took force in July, including the volume of kidney transplants, their matching efficiency, and post-transplant outcomes of their patients. But the role outside groups have played, including during the process of drafting the final rule, has prompted criticism and calls for additional scrutiny from Trump allies, including AFL.
Self-interested third parties should play no role in shaping America’s organ transplant policy,’ AFL counsel Laura Stell told Fox News Digital in a statement previewing the FOIA requests and broader investigation.
‘Where monetary incentives and penalties come into play, there must be utmost certainty that CMS developed the program without influence from entities with improper motives.’
America First Legal, though not officially part of the Trump administration, was founded by longtime Trump adviser Stephen Miller after Trump’s first presidential term.
Miller stepped down from AFL before rejoining the White House in 2025 as Trump’s deputy chief of staff.