Medicaid Fraud Watchdogs Under Fire At House Hearings

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Medicaid Fraud Watchdogs Under Fire At House Hearing

December 13, 2011 — 12:31pm ET | By Molly Bernhart Walker

Medicaid issued $21.9 billion in improper payments in fiscal 2011, but the program's improper payment rate of 8.1 percent in fiscal 2011 was still an improvement from the 9.4 percent improper payment rate in fiscal 2010, according to a Centers for Medicare and Medicaid Services official. Angela Brice-Smith, director of CMS's Medicaid integrity program, was one of several oversight officials who faced sharp criticism from lawmakers Dec. 7, at a House Oversight and Government Reform joint subcommittee hearing.

"That's really nice; but what I'm trying to tell you is that your normal is not good enough," Rep. Elijah Cummings (D-Md.) told the panel.

Gary Cantrell, assistant inspector general for investigations within the Health and Human Services Department, said fiscal 2011 Medicaid fraud enforcement efforts set records across the board with over 400 criminal convictions and $1.1 billion in expected recoveries.

But lawmakers were unimpressed with Brice-Smith and Cantrell's testimony before the government organization, efficiency and financial management subcommittee and the healthcare, District of Columbia and National Archives subcommittee.

Rep. Paul Gosar (R-Ariz.) asked them to grade themselves on their performance policing Medicaid waste, fraud and abuse. Brice-Smith responded by giving herself a C, "in light of the youngness of our program." Cantrell gave himself a B, to which Gosar shot back, "On behalf of the American people and I doubt that they would give you above a D. Don't you agree with me? I think so."

Lawmakers said they were frustrated with the slow pace of progress to reduce improper payments, especially in light of increased funding to oversight programs under the Affordable Care Act.

Cantrell's office hired close to 100 new investigators with funding provided under the law. Brice-Smith said that with or without the law improper payments will continue to be an issue. A repeal of the law, however, would affect the growth and expansion of oversight programs, she said.

For more:
- go to the hearing page (included prepared testimonies and archived video)

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Thank You FierceGovernment and Ms Walker.