WASHINGTON, D.C. – House Ways and Means Oversight Subcommittee Chairman Vern Buchanan (R-FL) today delivered the following opening statement at a Subcommittee hearing entitled “Efforts to Combat Waste, Fraud, and Abuse in the Medicare Program.”
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Remarks as prepared for delivery:
“Good morning, I want to thank the panel for coming and welcome you all to today’s hearing on ‘Efforts to Combat Waste, Fraud, and Abuse in the Medicare Program.’
“Nearly 60 million Americans, including four million in my home state of Florida, rely on the Medicare program to provide care. We have a responsibility to all of them, and to all taxpayers, to ensure that care is high quality, and that CMS is paying accurate and appropriate amounts to those providing the care. As it stands now, Centers for Medicare Services has not been in a position to ensure that this is the case.
“A couple weeks ago, I had a very helpful discussion with staff from CMS Center for Program Integrity, about their efforts to address improper payments. One issue we discussed is that the 10 percent error rate that is reported includes fraud, as well as overpayments, as well as underpayments. Or – put more succinctly, that 10 percent number doesn’t really tell us much about the program’s integrity. Problems with accurate and complete documentation make up a substantial portion, and it is impossible to extrapolate how much of the payments are actual loss to the trust fund and how much merely represent typographical error – CMS treats them the same.
“When trying to understand how much fraud is in Medicare, the answer is we simply don’t know.
“Understanding payment errors is important as every dollar reported lost in error serves to undermine the good work of the program and could represent a dollar that should be spent on providing care to beneficiaries. However, different types of errors require different analytics and different solutions.
“Last week, the Department of Justice and the Department of Health and Human Services announced charges for more than 400 individuals who claimed more than $1.3 billion in fraudulent payments. Bad actors are real and it is important that we continue to provide support for the effort to combat fraud. However, errors other than fraud require a different approach. This makes efforts to distinguish between fraud and other improper payments important. In the end we need to look for ways to reduce all types of errors and ensure that the mechanisms created to do this are working as intended.
“Today we are looking at how CMS addresses improper payments in Medicare. Over the past decade, enrollment in Medicare Advantage has tripled. A third of all seniors on Medicare rely on it and this number continues to grow. Because of this, we need to better understand the processes in place to oversee the program and what we can do to improve it. To that end, I look forward to hearing from the witnesses today.”