House Energy and Commerce Committee leaders want to know why contractors hired by the Centers for Medicare and Medicaid Services (CMS) to track down waste and fraud find so little in a system known for decades to be shot through with double billings, over-payments and other forms of corrupt, inefficient spending.
They would also like to why CMS officials act on so few of the waste and fraud referrals they get from a trio of the top out-sourced sleuths.
The questions arose from a June hearing before the panel’s oversight subcommittee in which officials from the Government Accountability Office (GAO) and the Department of Health and Human Services Inspector-General expressed worries about too little being found and too little of what is found being recaptured by the government.
“In 2007, antifraud contractors referred $835 million in over-payments to claim processors for repayment. Of the $835 million referred only 7 percent, or $55 million, was collected,” the committee said today. Government experts estimate that as much as $100 billion is lost annually to Medicare and Medicaid waste and fraud.
So, in letters to AdvanceMed, Health Integrity and Safeguard Services, committee chairman Rep. Fred Upton, R-MI, ranking minority member Rep. Henry Waxman, D-CA, oversight subcommittee chairman Rep. Cliff Stearns, R-FL, and the subcommittee’s ranking minority member, Rep. Diana DeGette, D-CO, asked for a long list of datasets, including among much else:
“For each year since 2007, data showing the number of Medicare fraud investigations initiated, the number referred to law enforcement agencies, the number of over-payments identified, the number of over-payments referred to MACs, and the number of new payment suspension requests.”
You can read the committee’s statement and the letters to the three contractors here.