House committee puts Medicare audit contractors on the hotseat

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Lawmakers are asking Medicare contractors for more information about how they go about identifying and reporting potentially fraudulent payments to the Centers for Medicare & Medicaid Services.

The request comes on the heels of a series of scathing reports about inefficiencies in Medicare's fraud-fighting programs. In letters to three Medicare contractors, members of the House Energy and Commerce Committee asked contractors to provide:

  • data from 2007 showing the number of fraud investigations initiated and the number of overpayments identified;
  • a description of factors influencing this data;
  • policies and procedures about how investigations are initiated;
  • policies and procedures describing how and when leads regarding Medicare and fraud are referred to law enforcement agencies
  • and policies and procedures for new payment suspension requests.

In June, the Government Accountability Office and the Health and Human Services Office of the Inspector General both released reports detailing the lack of oversight over such contractors as well as low overpayment recovery rates. Nursing homes increasingly are being targeted for audits by Medicare and Medicaid contractors.

Click here to read the contractor letters.