Baucus displays positive headlines of the investigative successes of the health care anti-fraud organizations. (Elena Schneider/Medill News Service)
“As the number of Medicare and Medicaid beneficiaries escalates, and funds to pay for those services become preciously stretched, it is imperative that we take a critical look at how tax dollars are being spent to reduce the amount of fraud, waste and abuse,” ranking committee member Sen. Orrin Hatch, R-Utah, said.
Dr. Peter Budetti, the director of the Center for Medicare & Medicaid Services, and Inspector General Daniel Levinson fielded questions from the committee on their new programs, partly funded by provisions in the Affordable Care Act.
“I’ve been asked two questions, why do we let crooks in and why do we pay fraudulent claims?” Budetti said. “We’re now making progress on both fronts.”
The Center for Program Integrity headed by Budetti and the Office of the Inspector General try to prevent fraud by investigating cases of system abuses.
The hearing began with the two officials offering posters that highlighted the success of these new health care anti-fraud organizations with newspaper headlines.
Soon both Democrats and Republicans demanded numbers.
“I want a quarterly report, with data, with numbers, with dates, with benchmarks,” committee chairman Sen. Max Baucus, D-Mont., said. “We want to help you and help each other to get these bad guys.”
The witnesses insisted these statistics — the amount of taxpayer money lost in health care fraud — are simply unavailable.
In a two-minute volley, Baucus asked for an exact figure, but neither witness gave one.
“I believe there is a significant dollar figure,” Levinson said. “All other numbers are estimates.”
Sen. Tom Coburn, R-Okla., turned the discussion to predictive modeling, a strategy to predict fraud, which is often used by private insurance companies, but has only recently been implemented on the federal level.
“If private insurance companies have a one percent fraud rate, why has it taken us so long to get to predictive modeling?” Coburn said with a finger pointed at both witnesses. “Are you recreating the wheel or are you taking something that works and applying it to Medicare?”
Many of the senators’ questions went unanswered.
“The old saying is, if you don’t shoot for a target, you’ll never hit it,” Sen. John Ensign, R-Nev., said. “So the next time you come before this committee, we’d like to see the goals so we can see if you reached them.”
