Republican lawmakers accuse CMS of focusing on recovering, not preventing, improper payments

The group of lawmakers who penned the letter includes Senate Finance Committee Chairman Orrin Hatch (R-UT)
The group of lawmakers who penned the letter includes Senate Finance Committee Chairman Orrin Hatch (R-UT)

The Centers for Medicare & Medicaid Services relies too much on investigating improper Medicare payments after they're made instead of preventing them to begin with, Republican lawmakers said Monday.

In a letter to CMS Acting Administrator Andy Slavitt, the chairmen of three Congressional committees expressed concern over the agency's reliance on the so-called “pay and chase” method of tracking down improper payments after they were made. The letter's authors include Senate Finance Committee Chairman Orrin Hatch (R-UT), House Ways and Means Committee Chairman Kevin Brady (R-TX), and House Energy and Commerce Committee Chairman Fred Upton (R-MI).

The pay and chase method is “outdated,” the lawmakers wrote, and takes away from efforts made in recent years to prevent improper payments, such as the Fraud Prevention System. The “enormous” issue came to a head last year when the Medicare Fee-for-Service Program had a 12.1% error rate, with 12 cents of every dollar being misspent, the chairmen noted.

“... Each dollar lost to fraud is a dollar that is not used to benefit patients,” the lawmakers wrote. “This represents a significant burden on the program and taxpayers."

The group requested CMS submit information on fraud investigations, “filters” used by the Fraud Prevention System to stop improper claims, the amount the prevention system has returned to the Medicare program, and the process the agency uses to monitor the effectiveness of the fraud prevention models. That information is due back to the lawmakers by Sept. 26.