WITNESSES PROVIDE RECOMMENDATIONS ON COMBATING WASTE, FRAUD, AND ABUSE
 

Washington, Mar 2 -

Rep. Cliff Stearns (R-FL), Chairman of the Oversight and Investigations Subcommittee of the Energy & Commerce Committee, concluded a hearing today on waste, fraud, and abuse in the Medicare and Medicaid programs. “Recently the Government Accountability Office listed the Medicare and Medicaid programs as ‘High Risk’ programs,” stated Stearns. “High Risk programs are identified as having ‘greater vulnerability to fraud, waste, abuse, and mismanagement.’”Although recognizing the occurrence of waste, fraud, and abuse, the Administration witness from the Center for Medicare and Medicaid Services (CMS) was unable to even venture an estimate on the amount although Stearns mentioned estimates of $60 to $90 billion a year.

Stearns asked Mr. John Spiegel, Director of Medicare Program Integrity for CMS, to provide an estimate.  Spiegel responded, “There is no actual one number…” and Stearns added, “So you don’t know.” Mr. Omar Perez, Assistant Special Agent in Charge, Office of the Inspector General for the U.S. Department of Health and Human Services, found “$3.7 billion in Medicare fraud” just in south Florida. Alexander Acosta, former Attorney Southern District of Florida, testified that his district “charged more than 700 individuals responsible for submitting more than $2 billion in fraudulent bills to Medicare” in south Florida from FY2006 through May 2009.

Stearns expressed deep concern with the Administration’s plan to drastically cut Medicare funding by $500 billion while dramatically increasing Medicaid spending under the health care law when it was unable to even guess what the costs are for waste, fraud, and abuse.

Although unable to identify the scope of the problem, the witnesses provided recommendations for reducing waste, fraud, and abuse.  Mr. Craig Smith, who previously served in the Florida Agency for Health Care Administration, provided specific recommendations.Testified Smith, “In my view, the best techniques are those that prevent improper payments in the first place. With a greater emphasis on pre-payment fraud and abuse prevention, we can decrease significantly the loss of taxpayer dollars and make healthcare fraud a much less desirable career path.”  He also provided five proven tactics for reducing waste, fraud, and abuse:

1. Maintain Better Control of the Provider Network.
2. Significantly Improve the Provider and Supplier Enrollment Screening Process.
3. Continue Shifting Reimbursement Methodologies Away from Fee-for-Service.
4. Increase the Role of Physicians in Detecting and Preventing Fraud.
5. Use Predictive Modeling and Other Enhanced Technologies.

“The purpose of the Oversight and Investigations Subcommittee is to ferret out details… We are going to forward these recommendations to the Health Subcommittee and they can hold a hearing and then follow up with legislation to curb this fraud,” concluded Stearns.