House Sees More Work Ahead on Medicare Fraud

House Lawmakers Say New Efforts to Limit Medicare Fraud Aren’t Doing Enough

congressbuildingThe Centers for Medicare and Medicaid Services says it has revoked the billing privileges of more than 20 thousand Medicare providers and suppliers since the implementation of the Affordable Care Act in 2010, recovering tens of billions of dollars.

“They are going to jail, there are criminal fines, there are criminal forfeitures that are applied, and that is the work that results in the recoveries,” Health and Human Resources Deputy Inspector General for Investigations Gary Cantrell said Wednesday during a hearing on Capitol Hill.

Despite progress, House Republicans criticized CMS saying more needs to be done to stop fraudulent providers that are still slipping through the cracks.

“They change their names and they start a new business. But it’s the same bad group of people,” said Rep. Marsha Blackburn, R-Tenn.

Blackburn also wants to remove sensitive information like names and social security numbers from Medicare cards to help prevent identity theft. CMS says that won’t be easy, requiring changes to dozens of systems across several agencies.

“When are you going to delink these and make certain that a social security number and a name do not appear on this card?” Blackburn asked Dr. Shantanu Agrawal, Deputy Administrator and Director of the CMS Center for Program Integrity.

“We are not as an agency opposed to the idea, it is however a challenging idea that requires a lot of sort of rigor to implement,” Agrawal said. “I think we need to be adequately resourced by the Congress to be able to do that.”

CMS says it is taking important steps to cut down on new fraud by temporarily stopping provider and supplier enrollment in areas with a high risk for fraud, including major cities like Houston, Chicago and Miami.


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