Senators: Stop $89B in Medicare, Medicaid Improper Payments

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By Thomas Beaton

– The US Senate Budget Committee has penned a letter to HHS Secretary Alex Azar urging the department to address approximately $89 billion in improper payments within Medicare and Medicaid.

The Senators referenced a recent GAO report suggested new auditing processes for CMS that would help to identify inappropriate payments in both Medicare and Medicaid. GAO also suggested the Office of Budget Management should develop a new risk-based methodology to help HHS and other federal agencies better assess the validity of payments.

Medicare and Medicaid improper payments accounted for 63 percent of the US government’s entire volume of improper payments.

“We are deeply concerned by the substantial amount of improper payments in these two programs,” the Senators said. “Your [Azar’s] attention is needed to ensure that taxpayer dollars are adequately safeguarded.”

The lawmakers added that HHS has not acted on any program integrity recommendations from Comptroller General Gene Dorado, which Azar and other HHS officials should remedy immediately.

On April 4, 2018, Dorado advised HHS to improve state-federal collaboration on Medicaid audits and increase Medicaid data availability for program oversight. In addition, Dorado suggested that HHS should monitor the Recovery Audit Data Warehouse used by Medicare auditors to ensure payments are properly reviewed.

The Senate Budget Committee believes that HHS needs to address improper payments by using GAO’s recommendations, which could help extend the financial solvency of Medicare’s Hospital Insurance Trust (HIT). Currently, the HIT is expected to be depleted by the year 2026 as Medicare spending continues to climb year over year.

The group concluded their letter by requesting written responses from Azar about the following action items:

  • The status of HHS’s actions in relation to GAO recommendations
  • Available information about HHS’s plans to take corrective action and implement GAO recommendations, along with timelines for completion.
  • Explanations from HHS about whether they agree or disagree with GAO’s recommendations to address improper payments in Medicare and Medicaid.

HHS has until July 20, 2018 to provide the Senate Budget Committee with responses to the questions. The Senators also asked HHS to provide quarterly progress on recommendations moving forward.