OIG Cites Performance Issues with CMS and Contractors

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Original story posted on: March 5, 2014

Noting that the Centers for Medicare & Medicaid Services (CMS) contractors are responsible for administering more than half a trillion dollars in Medicare benefits annually, the U.S. Department of Health and Human Services (HHS) Office of Inspector General’s (OIG’s) Robert A. Vito said Tuesday that the OIG has discovered a number of “recurring issues” that limit CMS’s oversight across all contractor types.

Vito, the regional inspector general for the HHS OIG, testified before the U.S. House of Representatives Energy and Commerce Health Subcommittee, saying that CMS had not “leveraged contractor (reporting) that would improve oversight.” Vito also reported that CMS had not “investigated variation in data across contractors to determine underlying causes, especially when it (was) not explained by the size or geographical jurisdiction of contractors.”

Tuesday’s congressional hearing, which was called to discuss opportunities to improve the Medicare program but also to address steps to reduce waste, fraud, and abuse, came just after CMS’s recent announcement that it is instituting a temporary pause in the RAC program until the agency completes its re-procurement of new recovery auditors.

Vito, in offering recommendations to improve what he described as “poor contractor performance,” said CMS should, among other things, “seek legislative change to give CMS more flexibility in awarding new contracts when Medicare Administrative Contractors (MACs) are not meeting CMS performance requirements.”

On the other hand, Health Subcommittee Chairman Rep. Joe Pitts (R-Pa.) praised work being done by recovery auditors but cited administrative problems that hinder contractor performance.

“Many of these contractors have valuable experience fighting fraud and efficiently managing health insurance programs,” Pitts said in his opening statement. “Yet sometimes, federal law or administrative barriers prevent us from using their expertise to prevent waste, fraud, and mismanagement in the Medicare program. Other times, all that is missing is a dose of common sense and leadership.”

One of the central themes during the hearing was the need to protect the Medicare Trust Fund, which is estimated to go bankrupt before the end of the decade.

“We must do everything in our power to safeguard the money in the trust fund,” Pitts warned, “until such time as Congress accepts its responsibility to make structural changes to save the program for the millions who depend on it.”

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Chuck Buck

Chuck Buck is the publisher of RACmonitor and is the program host and executive producer of Monitor Monday.

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