House Members Take Leavitt to Task over Fraud Funds

WASHINGTON–Legislators on the House Budget Committee put Health
and Human Services Secretary Mike Leavitt on the hot seat Tuesday
as he requested additional funds to fight Medicare fraud.

The Bush administration is asking for $1.3 billion for the
Health Care Fraud and Abuse Control program in 2008–$200 million
more than the program received in 2007. Of the increase, Leavitt
said most would be discretionary spending used to go after fraud in
Medicare and improve oversight of Medicaid.

Leavitt said much of the money was needed to pay for and
prosecute DME fraud cases in areas like South Florida, where CMS
recently announced a major anti-fraud demonstration project. (See
HomeCare Monday, July 9.) Leavitt
recounted his experience in visiting the area, where he told the
congressional panel Medicare is losing millions in payments to sham
companies. He said his department is also seeking to change
statutes that send recovered funds back into the Medicare trust
fund so that they go toward fraud prevention initiatives
instead.

But legislators questioned the agency’s fraud control efforts to
date and asked whether additional funding would be effective.

Rep. Jim Cooper, D-Tenn., said Medicare has let its claims
processing contractors “off the hook” and that they should be held
accountable. “Don’t these payment processors have some
responsibility to flag suspicious claims?” Cooper asked. “Are they
doing their job?”

Cooper also challenged Leavitt’s focus on small providers
instead of on large health care companies, which Cooper said seem
to regard penalties for Medicare fraud as merely a cost of doing
business.

According to the American Association for Homecare, which
reported on the hearing in its newsletter, Leavitt also got hard
questions from other congressmen, including Rep. Adrian Smith,
R-Neb., who asked, “How often are people on the front lines
included in the process of preventing fraud?” Rep. Bobby Scott,
D-Va., asked about professional education for providers that could
reduce mistakes. Rep. Dan Lungren, R-Calif., said he had hoped to
hear more in Leavitt’s testimony about deterring fraud. “That’s
what I found missing,” he said.

Rep. Patrick Tiberi, R-Ohio, mentioned the “hoops” providers
have to jump through to get reimbursed. He commended his state’s
“strong and active DME industry,” and suggested CMS work with DME
associations to go after fraud, AAHomecare said.

Committee ranking member Paul D. Ryan, R-Wis., said Congress
should look at reforms to ensure federal funds appropriated in the
regular budget process are spent wisely rather than appropriating
funds year after year for program integrity.