House Subcommittees Criticize CMS About Lack Of Audits Of Private Medicare Advantage Plans

Main Category: Medicare / Medicaid / SCHIP
Article Date: 18 Oct 2007 - 9:00 PDT

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Democrats from the House Ways and Means Health and Oversight subcommittees on Tuesday during a joint hearing said that CMS officials must ensure that private Medicare Advantage plans provide promised benefits and that the agency should seek to recover overpayments to the plans, CQ HealthBeat reports.

According to a Government Accountability Office report released in July, CMS has not audited the financial records of at least one-third of MA plans as required. From 2001 to 2005, CMS audited the financial records of about 18.6% to 23.6% of MA plans, and, in 2006, the agency audited the records of 13.9% of plans, according to the report. The report also found that in 2003, CMS officials found $35 million in overpayments to MA plans.

Timothy Hill, chief financial director and director of the Office of Financial Management at CMS, at the hearing testified that the agency has developed a plan to meet the requirement. CMS officials also said that they do not have the authority to recover overpayments to MA plans. Rep. Xavier Becerra (D-Calif.) said that CMS officials should seek such authority.

After the hearing, Hill said, "I can spend a lot of time thinking about 2001 to 2005 and the audits that are there, or I can spend a whole lot more time and resources making sure that for the plan year we're in now, we're paying appropriately and doing the things we need to be doing." Health Subcommittee Chair Pete Stark (D-Calif.) said, "If you think this program is helping beneficiaries and the integrity of the Medicare system, you should be able to provide detailed accounting of what is promised and delivered and explain how much is paid for these services," adding, "In a $73 billion program, we have no idea what benefits are being delivered. That's not good government; it's a dereliction of duty" (Carey, CQ HealthBeat, 10/16).

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