The U.S. House Oversight and Investigations Subcommittee, under the umbrella of the full Energy and Commerce Committee, dealt with Medicaid and Medicare fraud Wednesday -- and, while officials from the Obama administration could not provide solid numbers, other witnesses estimated that fraud and waste in these programs cost taxpayers between $60 billion and $90 billion.
Recently, the Government Accountability Office listed the Medicare and Medicaid programs as high risk programs, said Florida Republican U.S. Rep. Cliff Stearns, chairman of the subcommittee. High risk programs are identified as having greater vulnerability to fraud, waste, abuse, and mismanagement.
Stearns asked John Spiegel, director of Medicare Program Integrity from the Centers for Medicare and Medicaid Services (CMS), how much fraud cost taxpayers. He made it clear he was not happy with Spiegels "vague" answers.
While the administration did not provide solid answers, there were some startling numbers from the Sunshine State. Omar Perez,afrom thae Office of the Inspector General for the U.S. Department of Health and Human Services, said that Medicaid fraud costs from South Florida alone came to $3.7 billion. Alexander Acosta, who used to work in the U.S. attorneys office in the Southern District of Florida, noted that his office prosecuted more than 700 Medicare fraud cases in less than four years, which added up to more than $2 billion in fraud.
Another committee witness with ties to the Sunshine State -- Craig Smith, who served in the state Agency for Health Care Administration -- provided his ideas on how to cut down on fraud.
In my view, the best techniques are those that prevent improper payments in the first place, said Smith. With a greater emphasis on pre-payment fraud and abuse prevention, we can decrease significantly the loss of taxpayer dollars and make health care fraud a much less desirable career path.
Smith offered a number of ideas which he said would help reduce fraud, including better oversight of providers --that is, better screening of both providers and suppliers; reducing fee-for-service reimbursements; giving doctors more authority in reporting fraud; and using predictive modeling and new technologies.
Stearns promised that his subcommittee would continue to fight Medicaid and Medicare fraud and would also bring the matter to other subcommittees.
The purpose of the Oversight and Investigations Subcommittee is to ferret out details, said Stearns. We are going to forward these recommendations to the Health Subcommittee and they can hold a hearing and then follow up with legislation to curb this fraud.
Reach Kevin Derby at kderby@sunshinestatenews.com or at (850) 727-0859.
