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Chairman Jenkins Opening Statement at Hearing on Combating Fraud in Medicare: A Strategy for Success

July 17, 2018

WASHINGTON, D.C. –  House Ways and Means Oversight Subcommittee Chairman Lynn Jenkins (R-KS) delivered the following opening statement at a Subcommittee Hearing on Combating Fraud in Medicare: A Strategy for Success.

CLICK HERE to watch the hearing.

Remarks as prepared for delivery:

“Nearly 60 million individuals in the United States rely on Medicare for their health care.  In my home state of Kansas alone, almost one in five Kansans depend on the Medicare program.

“As one of the government’s largest and most complex programs, Medicare is highly susceptible to fraud, waste, and abuse.  Because of this, Medicare has been designated as a ‘high risk’ program for almost three decades.  In 2017 alone, improper payments accounted for nearly $52 billion dollars of Medicare spending. 

“Fraud in particular is often challenging to identify and measure due to its deceptive nature.  Fraud may also be nonfinancial, making it even more difficult to measure.  The Centers for Medicare and Medicaid Services, or CMS, measures improper payments, some of which may result from fraud.  However, while CMS identifies improper payments through the Comprehensive Error Rate Testing, or CERT program, it is difficult to get a clear understanding of which improper payments are a result of fraud and which are simply a mistake.

“So how much fraud is in the Medicare program?  Right now, there are varying opinions but the bottom line is it is too much.

“Currently, Medicare antifraud efforts focus on identifying fraud after it has occurred in a pay-and-chase format.  Instead, CMS should focus on identifying and assessing where there is a risk of fraud before it happens, which I understand CMS is starting to do.  Fraud risk exists when there is the incentive, opportunity, or pressure to commit fraud.  By focusing on and mitigating fraud risk in Medicare, CMS can reduce the likelihood and impact of fraud in the program, preventing it before it occurs.

“The Government Accountability Office, or GAO, developed the Fraud Risk Framework in 2015 in order to guide agencies’ efforts to combat fraud.  Congress liked the Framework so much that we passed the Fraud Reduction and Data Analytics Act of 2015, requiring federal agencies to incorporate leading practices from the Fraud Risk Framework. 

“As it stands now, there is no comprehensive risk-based strategy for combating fraud in Medicare.  And CMS has not conducted an assessment of Medicare using the Framework that would allow it to develop such a strategy.  Without a strategy in place, it is very difficult to address fraud. 

“Today’s hearing will cover ways in which CMS can continue to improve its antifraud efforts, including the development of a comprehensive antifraud strategy.  The witness panel will provide helpful updates on CMS’s current antifraud efforts and where there is room for improvement.  Our goal here today is to better understand what needs to be done to more effectively combat fraud in Medicare and to support those efforts however we can.  Unfortunately, at CMS there seems to be some level of acceptance of the improper payment amount.  However, I know this is something every Member of this Subcommittee wants to improve.  Particularly, given that every dollar lost to fraud is a dollar that could be spent on patients.

“I want to thank our witnesses for being here today and I look forward to their testimony.”