Congress urges CMS to fight Medicare fraud with moratoriums

Even though health reform gave the Centers for Medicare & Medicaid Services (CMS) authority to impose moratoriums on new Medicare providers and suppliers when there's a high risk of fraud, waste, and abuse, the agency has failed to do so.

In fact, after more than eight months, federal health officials haven't imposed a single one, Sens. Chuck Grassley (R-Iowa) and Orrin Hatch (R-Utah) wrote in a letter to Health & Human Services (HHS) Secretary Kathleen Sebelius, which urged federal health officials to use the powerful tool to protect the Medicare program from fraud.

"It is not reasonable to suggest that CMS needs more time to study whether there is need to impose a temporary moratoria in certain geographical areas for certain provider and supplier types when ample evidence exists from the strike force activities to justify moratoria in these high fraud areas," they noted.

The Department of Justice and HHS already are operating anti-fraud initiatives in California, Florida, Illinois, Louisiana, Michigan, New York, and Texas--all high-fraud states. These fraud hot spots also are all obvious places to consider imposing moratoriums, notes the Associated Press.

So what is CMS waiting for? The agency is in the process of developing ways to impose moratoriums that will prevent fraud without hurting providers and beneficiaries appropriately using Medicare, Dr. Peter Budetti, deputy chief of CMS' integrity division, told the AP.

"We wouldn't want to reduce (beneficiaries') access to legitimate providers erroneously," he said.

For more:
- here's the press release
- read the Associated Press article

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