Seems like every time we turn around there’s a new report on Medicare’s ability — or lack thereof — to monitor for fraud.
Last week, there was a hubbub over a draft report that said Medicare directed an auditor to use improper methods in an anti-fraud audit related to durable medical equipment. That came on the heels of a GAO report about equipment fraud. There were also scams involvingdead doctors, AIDS care and some guy who bilked a bunch of money from Medicare and bought a Rolls Royce.
Now, the fraud issue du jour: the Medicare drug benefit. The Government Accountability Office came out with a report today that says some insurers sponsoring Medicare drug plans haven’t put in place all the fraud controls they’re supposed to. For instance, some haven’t met requirements for employee training and internal monitoring and auditing. Click on the icon below to read the report.
Medicare’s oversight has been “limited,” and the agency hasn’t audited the plans to make sure their controls are up to snuff, the GAO said. A lack of oversight “risks significant misuse of funds in this $39 billion program.”
Medicare’s acting administrator, Kerry Weems, disagreed with the finding that its oversight had been limited, pointing out in a letter that the agency has monitored fraud and abuse complaints, taken action in response, provided detailed guidance to the plans on fraud control and gathered information from them on their programs. But Weems added that inadequate funding has stymied heavy oversight. A Medicare Integrity Program funding cap has “seriously degraded [Medicare's] ability to meet its responsibilities in combating fraud and abuse,” he wrote.
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