According to the report, in 2014, Medicare paid $554.2 billion for health care and healthcare-related services, and it is estimated that 10.8 percent of those payments ($59.9 billion) were improper. This total includes both underpayments and overpayments, but is a clear illustration that additional reforms are necessary to improve the payments and approval system. Preventing illegitimate providers and suppliers from enrolling in Medicare is the first step to keeping bad actors out of the Medicare program.
In 1998, Senator Collins chaired several hearings in the Permanent Subcommittee on Investigations (PSI) to examine fraud in the Medicare program. Those hearings uncovered dramatic examples, such as payments of $117,000 to two so-called physicians whose address was actually a laundromat in Brooklyn, and $6 million to durable medical equipment companies supposedly headquartered in the middle of a runway at Miami International Airport. Today, Senator Collins said, “Seventeen years after I chaired those hearings, I am dismayed to learn that improper payments are still flowing to con artists who bilk the system from fictitious or inappropriate locations.”
Senator Collins said that she was particularly troubled by CMS’s lack of efforts to ensure that health care providers who are enrolled in Medicare are actually eligible for the program. She questioned whether CMS was continuously monitoring the lists of eligible providers.
The hearing was titled “The Doctor Is Not In: Combating Medicare Provider Enrollment Fraud,” and witnesses included Shantanu Agrawal, Deputy Administrator of the Centers for Medicare and Medicaid; Seto Bagdoyan, director of Audit Services at GAO and Katherine Leff, director of the special investigations unit for CareSource Management Group.
WASHINGTON, D.C. – The Senate Special Committee on Aging, led by Chairman Susan Collins and Ranking Member Claire McCaskill, today held a Committee hearing to examine a new report by the Government Accountability Office (GAO) that found nearly a quarter of approved Medicare provider applications contained potentially ineligible addresses such as a fast food restaurant and UPS stores. In addition, the report found that several physicians who no longer had their medical licenses were eligible to receive payments from Medicare. These findings are indicative of vulnerabilities in the program that could lead to waste, fraud and abuse of the Medicare program.
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