Senators Urge CMS To Reform Medicare Fraud Prevention Program
Last week, a bipartisan group of senators urged the Obama administration to reform a program designed to identify and deter Medicare fraud following an HHS Office of Inspector General report that found the program to be ineffective, The Hill's "Floor Action Blog" reports (Cox, "Floor Action Blog," The Hill, 1/11).
The OIG report looked into activities from April 2010 to March 2011 and found that the Medicare Drug Integrity Contractor, or MEDIC, program identified most of the few cases referred to law enforcement through passive and external means, such as a fraud hotline, rather than proactive, internal means, such as research and investigation. Specifically, the report found that:
- Only 21 of the 223 identified cases of fraud in Medicare Part D were spotted through internal means;
- Only two of the 19 identified cases of fraud in Medicare Advantage were spotted through internal means (Ethridge, CQ HealthBeat, 1/11).
The report also noted that CMS has not established a database to help MEDIC -- which has a $14 million annual budget -- identify potential fraud. The report made a number of suggestions to improve MEDIC's fraud detection practices.
Sens. Max Baucus (D-Mont.), Tom Carper (D-Del.), Tom Coburn (R-Okla.) and Orrin Hatch (R-Utah) recommended that CMS follow HHS OIG's suggestions for reform ("Floor Action Blog," The Hill, 1/11).
Of those reforms, CMS has agreed to:
- Share centralized data on Medicare Advantage with MEDIC since there currently is no centralized Medicare Advantage database;
- Clarify policies on when MEDIC can share information with other program integrity contractors; and
- Increase MEDIC's monthly workload reporting requirements to improve CMS' oversight of the group.
In addition, CMS partially agreed to require plan sponsors to refer potential fraud to MEDIC and look for ways to reimburse MEDIC when law enforcement rejects a referred case.
CMS did not agree with the recommendation that it give MEDIC the authority to obtain information directly from pharmacies, physicians and pharmacy benefit managers (CQ HealthBeat, 1/11).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.