CMS lessens pressure over improper Medicaid payments and House committee balks

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Members of the House Energy and Commerce Committee are investigating why the Centers for Medicare & Medicaid Services has raised its Medicaid improper payment rate target for fiscal year 2015.

In a letter to CMS, Republican committee leaders asked CMS acting administrator Andy Slavitt why the organization planned on “accepting the upward trend in improper payments” by raising its target rate, instead of setting goals to reduce improper payments.

CMS had an estimated improper payment rate of 6.7%, or $17.5 billion, for Medicaid in fiscal year 2014. That was up from an estimated 5.8% for 2013. Therefore, for fiscal year 2015, CMS raised its target rate for improper payments to 6.7%. The House committee urges CMS to seek out fraud and abuse in order to reduce improper payments, noting “even a small percentage of improper payments represent billions of taxpayer dollars.”

“It is setting the bar so low… we had a goal of 5.6 [percent], we hit 6.7, so the next year let us make it 6.7,” Rep. Chris Collins (R-NY) is quoted as saying at a recent hearing in the letter. “Well, if it is 7.2, then the next year it is going to be 7.2.”

The letter requires CMS to provide all documents related to raising the rate, and a description of the decision process, by July 15.