CMS pressed to approve Medicare fraud rules

by Ferdous Al-Faruque - 05/20/14 10:15 AM ET

Government oversight agencies on Tuesday said the Centers for Medicare and Medicaid Services had taken important steps to cut down on fraud and abuse but urged administrators to go further and finalize additional rules.

Before a hearing of the House Oversight subcommittee on healthcare, Kathleen King, the General Accountability Office’s director of healthcare, and Brian Ritchie, an acting deputy inspector general at the Health and Human Services Office of Inspector General, listed a number of steps the agency could take to further prevent or recoup losses from fraud.

King told lawmakers that the CMS had estimated that “improper payments in the Medicare program were almost $50 billion in fiscal year 2013.”

The officials pressed the CMS to adopt tougher enrollment requirements and prepayments to ensure the government could be reimbursed if billed incorrectly.

Under one proposed rule, certain at-risk providers and suppliers, such as home health agencies and independent diagnostic testing facilities, would be required to hold so-called surety bonds, which could be used to repay the CMS in cases when the agency was over billed. The CMS already requires some medical equipment suppliers to hold such bonds.

They noted that the CMS has also not yet finalized a rule that would require health providers and medical equipment suppliers to disclose any past billing issues with the government before enrolling to provide Medicare services. Those tougher requirements would prevent companies that raised concerns in the past from continuing to participate in Medicare.

Ritchie also criticized the CMS’s oversight of the Medicare Part D prescription drug program.

“OIG has extensively examined CMS’s monitoring and oversight of the Part D program and the effectiveness of controls to ensure appropriate payment and patient safety,” he said. “Our work has found limitations in program safeguards that leave Part D vulnerable to improper payments and Medicare patients vulnerable to potentially harmful prescribing.”

He said the CMS has proposed a rule that would require prescribers of Part D drugs to be enrolled in the Medicare fee-for-service program but hasn’t finalized the rule.

“If implemented it could help CMS, Part D plans, and the Medicare program integrity contractor enhance their monitoring and better prevent and detect Part D improper payments and potential fraud,” he added.

Tags Health Healthcare reform in the United States Medicare