Lawmakers blast federal efforts to monitor and police Medicare fraud -- again

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Lawmakers blast federal efforts to monitor and police Medicare fraud -- again
Lawmakers blast federal efforts to monitor and police Medicare fraud -- again

Lawmakers again hammered the Centers for Medicare & Medicaid Services' Medicare program integrity contractors Friday. The latest salvos were fueled by an agency admission that additional mistakes had been made.

Two days prior to a House Energy and Commerce Subcommittee on Oversight and Investigations hearing about the shortcomings of Medicare program integrity contractors, CMS officials alerted Subcommittee Chairman Rep. Cliff Stearns (R-FL) that performance data it had previously submitted was inaccurate. This further compounded scrutiny CMS officials were put under by committee members and representatives from the Department of Health and Human Services Office of the Inspector General.

Rep. Diana DeGette (D-CO) testified that the OIG has had decade-long concerns with the program. She said OIG reports have repeatedly raised questions about whether contractors are using uniform standards to identify fraud; the frequency with which contractors report fraud to the proper authorities; the responsiveness of CMS to contractor concerns; and payment recovery rates.

Recovery audit contractors are tasked with auditing provider Medicare claims and identifying cases of fraud. Nursing homes increasingly are being targeted for such audits.

Responding to these concerns, Ted Doolittle, the CMS' deputy director for policy at CMS's Center for Program Integrity apologized for recent slipups. He added that recovery audit contractors collected roughly $1 billion in overpayments during the first quarter of fiscal year 2012.

Click here to listen to the hearing.

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