Congress questions CMS, OIG on MU incentive fraud
On the heels of an indictment that accused a former Texas healthcare executive of collecting $800,000 in EHR incentive payments under false pretenses, lawmakers from the House Committee on Energy and Commerce are looking for answers from the Centers for Medicare & Medicaid Services (CMS) and the Office of Inspector General (OIG) on why fraud is happening within the program.
“The case in Texas raises broader questions about CMS’ ability to detect fraud in its programs,” wrote Committee Chair Fred Upton (R-Mich.), Michael Burgess, MD (R-Texas) and Chair Emeritus Joe Barton (R-Texas) in letters sent to CMS Administrator Marilyn Tavenner and Department of Health & Human Services Inspector General Daniel Levinson.
The congressmen asked the agencies to provide a brief answering specific questions by March 12.
OIG was asked:
- What recommendations has the OIG made to CMS relating to improving the screening of providers or fund recipients?
- What actions is the OIG taking to examine how CMS could improve screening of providers or fund recipients?
- What other federal databases could CMS use to screen providers or fund recipients?
CMS was asked:
- What is the status of CMS efforts on predictive modeling used to develop provider characteristics?
- What have been the accomplishments by Zone Program Integrity Contractors to improve provider screening over the last year?
- What actions has CMS taken to screen providers using the General Systems Administration database on contract debarments, the Inspector General exclusions and Social Security Administrator master death file?
- Has CMS coordinated with the FDA on that agency’s debarment and disqualification lists?
- What other federal databases could CMS use to screen providers or fund recipients?
- How does CMS assure that the agency is alerted to credible fraud allegations concerning providers or fund recipients? What is CMS' authority for stopping payments to a provider or recipient under investigation for fraud?
- How many revocations of Medicare providers have occurred since Jan. 1, 2004?
For more information, read the CMS letter and the OIG letter.