GOP leaderships issue warning to CMS: Medicare fraud is rampant and more must be done

Major Republican lawmakers are worried that the federal government hasn’t done enough to fight Medicare fraud and members of the House Ways and Means Committee and Energy and Commerce Committee penned a letter to the Centers for Medicare and Medicaid Services, stressing that 12 cents of every Medicare dollar was misspent last year. Total fraud payments were $43 billion.

The letter said the i leading cause of fraud called “pay and chase,” in which the federal government pays a Medicare claim from a doctor or hospital before investigating whether it was a fraud.

While CMS has made progress on fighting “pay and chase,” the agency relies “too heavily on investigating claims after the payments have been made rather than preventing them in the first place,” the letter to acting CMS administrator Andy Slavitt reads. The letter asks CMS about how it is tamping down fraud and moving away from “pay and chase.” For instance, it wants to know how many investigations were conducted by the agency’s fraud prevention system over the past three years.

It said that the top Medicare services affected by fraud include home health and hospice care.

Energy and Commerce Chairman Fred Upton, Ways and Mean Chairman Kevin Brady, Reps. Peter Roskam of Illinois, Pat Tiberi of Ohio, and Tim Murphy and Joseph R. Pitts of Pennsylvania signed the letter. Sen. Orrin Hatch, chairman of the Senate Finance Committee, also joined the letter.

Jeffrey Newman represents whistleblowers.