Statements and Speeches
Hearing Statement: Creating a More Efficient and Level Playing Field: Audit and Appeals Issues in Medicare
Apr 28 2015
WASHINGTON – Today, Sen. Tom Carper (D-Del.), a member of the Senate Finance Committee, released the following statement regarding the committee’s hearing on “Creating a More Efficient and Level Playing Field: Audit and Appeals Issues in Medicare.”
“Without doubt, we must ensure that Medicare continues to provide critical care to our nation’s seniors and the disabled, and at the same time finds ways to contain the growth of health care costs. I believe we can do both. And one critical approach for an effective, and cost-effective, Medicare program is to have appropriate and smart oversight and auditing.
“We need to make sure that taxpayer dollars are spent on appropriate health care services that are needed by Medicare beneficiaries. The Government Accountability Office estimates that almost $46 billion of the Medicare fee-for-service expenditures were lost due to improper payments in the last fiscal year. Unfortunately, that level has been increasing during the past few years.
“Medicare oversight and audits are conducted by a number of different types of oversight contractors working for the Centers for Medicare and Medicaid Services (CMS). Not surprising, the alphabet soup of oversight can be confusing to anyone. My staff has heard complaints regarding reviews of Medicare claims conducted by each type of audit, and the ongoing and understandable confusion about which auditor is looking at a claim. In addition, I have heard from Delaware hospitals about the financial burdens placed on health care providers from the oversight of Medicare claims by CMS and its audit contractors. Clearly, we can do a better job to identify unnecessary and ineffective oversight steps that put a burden on doctors, hospitals and other providers, and make sure CMS has a better process to help providers make their way through the maze of audits and rules.
“Furthermore, a key element of the Medicare auditing programs is to prevent overpayments before they are made. When a consistent error or payment vulnerability is identified by the auditing contractors, Medicare officials are supposed to keep track of the problem. CMS is then supposed to address the problem, by either changing how payments are approved and reviewed, or by communicating a solution or clarification to the health care provider community. However, I understand that a change in law is needed to allow some of the Medicare overpayment recoveries to be used for this outreach, which of course would help prevent future overpayment and reduce the burden on providers.
“As the Members of the Senate Finance Committee are well aware, the Medicare ‘doc fix’ legislation – also known as the Medicare Access and CHIP Reauthorization Act – was enacted earlier this month. The legislation included some very good improvements to program integrity, including how the CMS and its contractors reach out to health care providers to ensure a strong understanding of Medicare payment rules. I was also happy that the ‘doc fix’ legislation included some important provisions of a bill I introduced this year, called the Preventing and Reducing Improper Medicare and Medicaid Expenditures Act, that consists of a range of steps to prevent waste and fraud. However, one provision of my legislation that did not make it into the new ‘doc fix’ law would have provided more resources for Medicare provider outreach and education. I hope to find other avenues to provide these resources.
“From the testimony of the witnesses, and from past hearings of the Committee, I think there are a lot of straightforward and helpful steps to improve the Medicare audit rules and procedures. I am committed to working with the committee, the administration and the many stakeholders to improve how audits are performed.”