Republicans Seek Anti-Fraud DetailsConcerned About Fake Companies Billing Medicare, Medicaid
Four Republican healthcare leaders in Congress are questioning whether the Medicare and Medicaid programs are doing enough to crack down on shell companies submitting fraudulent claims.
In a letter to Marilyn Tavenner, acting administrator of the Centers for Medicare & Medicaid Services, the lawmakers ask for a description of CMS's efforts to identify individuals and organizations that establish false storefronts and shell companies - paper-only firms with no real operations - and then submit fraudulent claims.
The Republicans sent the letter expressing their concerns in the wake of a March 7 indictment that alleged a fake home care provider swindled $20 million from Medicare over five years. "This indictment, along with other examples ... demonstrate that CMS's provider screening efforts are still not effectively safeguarding the Medicare program from individuals intent on committing fraud within the Medicare program," the letter states.
The letter asks CMS to provide a list of safeguards Medicare enrollment contractors are using to verify the identity of providers and owners. And it requests an explanation of the process CMS uses "to determine which categories of providers and suppliers are deemed 'high risk' and explain why non-physician owned clinics are currently viewed as 'low risk.'"
The lawmakers who submitted the letter are Sen. Orrin Hatch, R-Utah; Sen. Tom Coburn, R-Okla.; Rep. Wally Herger, R-Calif.; and Rep. Charles Boustany, R-La.