Lawmakers press administration on Medicare fraud

Lawmakers on Tuesday accused the Obama administration of being slow to implement inspector general recommendations on fraud in the Medicare prescription drug program. 

At a hearing of the House Energy and Commerce oversight subcommittee, lawmakers pointed out that the administration has not fully implemented nine recommendations from the inspector general to crack down on fraud in the program, known as Medicare Part D, even though some of those recommendations were made as far back as 2006. 

A Department of Health and Human Services Inspector General report in June found the administration is “missing opportunities to leverage data to identify fraud, waste, and abuse.”

{mosads}For example, it said that the administration’s Centers for Medicare and Medicaid (CMS) does not require the private insurance companies that administer the plans to report information on fraud. Fewer than half of the companies voluntarily report the information. 

The report also found that CMS paid over $1 billion in 2009 for drugs prescribed by people who did not have the authority to do so, such as nutritionists. 

Panel Chairman Tim Murphy (R-Pa.) told Dr. Shantanu Agrawal, director of the CMS Center for Program Integrity, that by the time he next testifies before the committee, the recommendations should be implemented.

“Some have been sitting around for more than ten years, and that’s just not acceptable,” Murphy said. 

Rep. Diana DeGette (Colo.), the top Democrat on the committee, did not take as sharp a tone as some Republicans, but also said more work can be done. 

“Part D remains vulnerable to fraud, and there are additional opportunities to identify fraud, waste and abuse,” she said. 

Agrawal said that the administration is working on the recommendations but that they take time.  

“On every recommendation, we have worked to make progress,” he said. “These recommendations do take time to implement.”

Fraud in the program is linked to the opioid abuse crisis, as doctors can illegitimately prescribe drugs that are abused. 

“We’re talking about a funding stream from the federal government that is helping to facilitate the use of narcotics in our country,” said Rep. Larry Bucshon (R-Ind.). 

Shortly before the hearing began, CMS announced that its analytics system had identified or prevented in $820 million in inappropriate payments in the program’s first three years. 

The administration also touted a June fraud takedown that resulted in charges for 243 people over $712 million in false billings.