Grassley: CMS too soft on contractors

The Centers for Medicare and Medicaid Services' oversight of its contractors is too lax, according to a letter Sen. Chuck Grassley (R-Iowa) sent to HHS Secretary Kathleen Sebelius and CMS Administrator Donald Berwick.

"I have been concerned and puzzled that CMS does not seem to examine its contractors' role in enabling taxpayer dollars to be misused or wasted and to hold contractors accountable if they fail to carry out their responsibilities as expected," he wrote in a letter dated Oct. 6.

In a statement, Grassley added, "The Centers for Medicare and Medicaid Services is not holding contractors accountable when those contractors fail to carry out their responsibilities or fulfill contract terms. The Centers for Medicare and Medicaid Services needs to do what it takes to make sure these contractors don't waste taxpayer dollars."
Something at CMS apparently isn't running as well as it should. The Office of the Inspector General found that $4.7 million in improper payments were made to providers in 2009. Forty percent of the inaccurate payments went to inpatient hospitals, while 25 percent went to durable medical equipment suppliers and 12 percent went to hospital outpatient departments. Seven percent went to physicians.

Grassley's letter cites a 2004 lawsuit that resulted in a $445 million judgment against All-Med Billing Corp. and its owners, and wanted to know why there was no review of Medicare Administrative Contractor, Palmetto Governmental Benefits Administrator, for its role in enabling fraud, waste and abuse. As the letter notes, Palmetto GBA allowed millions to be paid to the DME companies for fraudulent claims.

Grassley also wants to know what CMS is doing to ensure that contractors are held accountable when they fail to fulfill contracts or other legal arrangements with CMS. "What is HHS doing to ensure CMS effectively oversees and manages its contractors to prevent fraud, waste and abuse in the Medicare and Medicaid programs?" his letter asks.

To learn more:
- read the press release from Sen. Chuck Grassley's office
- here's the letter Sen. Grassley sent Secretary Sebelius and CMS Administrator Donald Berwick
- check out this Mass Device article
- read the McKnight's piece

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