When federal investigators visited the address listed for a Medicare provider last December, they instead found a fast food restaurant.
That’s not unusual for federal investigators dealing with the Centers for Medicare and Medicaid Services, the section of the Department of Health and Human Services that oversees Medicare and made $60 billion in improper payments in fiscal year 2014.That $60 billion accounted for more than 10 percent of everything spent on health care services by the federal government in 2014, according to the Government Accountability Office.
Medicare is the federal government’s primary health care program for Americans 65 and older. The new GAO report makes it clear why the congressional watchdog lists Medicare as a “high-risk” program, year after year.
One in five Medicare providers, like the one that turned out to be a fast food chain location, is using a potentially “ineligible” address, the GAO found. Such addresses are red flags Medicare fraud and abuse.
CMS requires providers to list their actual practice location, but a GAO dive into 2013 data found 23,400 of 105,234 locations are “potentially ineligible.” The report suggested there will be more such addresses because in 2014 CMS “reduced the amount of independent verification conducted by contractors, thereby increasing the programs’ vulnerability to potential fraud.”
The screening software used by CMS can’t detect potentially ineligible addresses like post office boxes, vacant lots and fast food franchises.That isn’t the only problem GAO investigators found with CMS’ oversight of one of the federal government’s most expensive programs.
Federal investigators also found officials failed to remove 147 physicians who failed to tell CMS that they had been found guilty by a state medical board of criminal activity. It took CMS months longer than it should have to remove some of those doctors from the system, and CMS “never removed” others, the GAO found.
Here are 10 things the federal government could pay for with the $60 billion CMS misspent in 2014.
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