WASHINGTON--(BUSINESS WIRE)--Citizens Against Government Waste (CAGW) today slammed the Center for
Medicare and Medicaid Services (CMS) for engaging in a nebulous
settlement agreement with 1,900 hospitals, paying 300,000 hospital
claims that had already been denied by two levels of CMS auditors as
medically unnecessary. Hundreds of thousands of denied claims were stuck
in the Department of Health and Human Services (HHS) Office of Medicare
Hearings and Appeals (OMHA) and the settlement, which offered a partial
payment of 68 cents for every $1 on a denied inpatient claim in exchange
for hospitals agreeing to the dropping their appeals, was CMS's solution
to breaking that logjam. The payments of $1.3 billion as of June 1, 2015
will be withdrawn from the Medicare Trust Fund, which is facing
insolvency. In keeping with the Obama administration's abysmal record on
transparency, the CMS statement on the settlements fails to identify
which hospitals received money.
The settlement process was murky from its inception. On August 29, 2014,
CMS announced the global financial settlement for hundreds of thousands
of Medicare fee-for-service claims that had been denied twice and then
appealed by providers to the third level of appeals, the administrative
law judges (ALJ). The vast majority of these claims were related to
short inpatient hospital stays (an area that had been identified by CMS
as highly vulnerable to improper payments), and had been denied at two
lower levels, including by Recovery Audit Contractors (RACs). The
appeals backlog had brought OMHA
to a standstill. At an April 28, 2015 Senate Finance Committee
hearing, OMHA Chief ALJ Nancy Griswold testified that between fiscal
year (FY) 2009 and FY 2014 OMHA's workload had jumped by 543 percent,
the number of appeals the agency received rose from approximately
384,000 in FY 2013 to 474,000 appeals in FY 2014, and adjudication times
increased to 572 days. As a result of the hospitals "appeal everything"
strategy, OMHA was forced to suspend new requests for hearings, a hiatus
that is expected to last two years.
The Medicare fee-for-service program has the highest level of improper
payments of any federal program, $46 billion in 2014 alone. In its 2015
annual report
on "Opportunities to Reduce Fragmentation, Overlap, Duplication, and
Improper Payments and Achieve Other Financial Benefits," the Government
Accountability Office identified Medicare as one of the biggest drivers
of the increase in improper payments government wide, noting that "For
the first time in recent years, the government-wide improper payment
estimate significantly increased--to $124.7 billion in fiscal year 2014,
up from $105.8 billion in fiscal year 2013. This increase of almost $19
billion was primarily due to estimates for Medicare, Medicaid, and the
Earned Income Tax Credit, which account for over 76 percent of the
government-wide estimate."
"This $1.3 billion settlement is indicative of how endangered program
integrity efforts are at CMS," said CAGW President Tom Schatz. "The lack
of transparency in the hospital settlement process should be a cause of
major concern to taxpayers, members of Congress, and Medicare
beneficiaries. Furthermore, the suspension of RAC audits, coupled with
this settlement, means that a portion of the $9.7 billion in improper
payments that have been recovered by RACs for the Trust Fund over the
last several years has now been sent back to the very providers who
systematically flooded the OMHA with appeals over denied claims.
Providers have not only managed to fend off oversight of hundreds of
thousands of potentially improper claims, they have been rewarded
financially for doing it. This is a terrible precedent and deserves a
full investigative hearing before jurisdictional committees."
Citizens
Against Government Waste is a nonpartisan, nonprofit organization
dedicated to eliminating waste, fraud, mismanagement and abuse in
government.
http://www.businesswire.com/news/home/20150612005930/en/CAGW-Slams-CMS-Secretive-Settlement-Payments-1.3
belligerentclif25 Community Member 
|
|
