WASHINGTON, D.C. – House Ways and Means Oversight Subcommittee Chairman Lynn Jenkins (R-KS) announced today that the Subcommittee will hold a hearing, entitled “Combating Fraud in Medicare: A Strategy for Success,” on Tuesday, July 17, at 10:00 AM in room 1100 of the Longworth House Office Building. The hearing will focus on how the Centers for Medicare and Medicaid Services (CMS) identifies and manages fraud risk in the Medicare program.

Upon announcing the hearing, Chairman Jenkins said:

“Medicare is an important program for many Americans. Almost one in five Kansans rely on Medicare as their source of health care. Unfortunately, given the program’s large size and complexity, it is highly susceptible to fraud, waste, and abuse. Right now, there is no comprehensive strategy for identifying and mitigating fraud risk in the Medicare program. Without both metrics and a strategy in place, it is challenging to even measure if efforts to combat fraud are successful.  I look forward to hearing from our witnesses about ways CMS can improve its Medicare program-integrity initiatives.”

BACKGROUND

Established in 1965, Medicare provides health coverage to individuals 65 and over and certain individuals with disabilities.  As of the beginning of 2018, Medicare covered nearly 60 million individuals.  Medicare is particularly vulnerable to fraud and other improper payments, prompting the Government Accountability Office (GAO) to identify the program as “high risk” for nearly three decades.

Fraud risk exists when there is the opportunity, incentive, or pressure to commit fraud.  Given the difficulty of measuring actual fraud, GAO developed the Fraud Risk Framework to provide metrics for success when combating fraud in Medicare.  The Framework outlines methods of identifying and mitigating fraud risk in order to reduce the likelihood and impact of fraud.  The Fraud Reduction and Data Analytics Act of 2015 mandated the Office of Management and Budget issue guidelines for federal agencies, including CMS, to incorporate leading practices of GAO’s Fraud Risk Framework.