House Subcommittee Schedules Hearing on Fraud in Medicare

The hearing witness panel consisted of the following two government representatives:

James Cosgrove
Director, Health Care, Government Accountability Office
Download his testimony here.

Jonathan Morse
Acting Director, Center for Program Integrity, Centers for Medicare and Medicaid Services
Download his testimony here.

To watch a recording of the roughly one-hour hearing, click here.

As is often the case when the GAO testifies, Mr. Cosgrove’s written testimony is essentially a study released to coincide with a related hearing.  Mr. Cosgrove’s statement is titled, “Medicare Advantage Program Integrity:  CMS’s Efforts to Ensure Proper Payments and Identify and Recover Improper Payments.”

Mr. Cosgrove’s comments focused primarily on the Medicare Advantage or “Part C” Medicare program. He also discussed risk adjustment data validation (RADV) audits that the Centers for Medicare and Medicaid Services (CMS) conducts and how long they take.

Mr. Morse discussed the Center for Program Integrity’s efforts to address improper payments across all parts of Medicare (Parts A, B, C and D), explaining that improper payments can represent not just fraud, was waste and abuse as well.

Several Senators asked for insight about the amount of fraud in Medicare fee-for-service compared to Part C. Mr. Morse was asked to comment on the aspects of the Affordable Care Act that help to bolster fraud fighting in federal programs. He acknowledged the valuable tools the ACA provided for fighting fraud, while also highlighting other valuable legislation passed in recent years.