“The lack of a more robust set of CMS internal processes regarding access to services under the Medicare Part D program has been a concern to CMS,” a response from the agency said. “CMS is taking steps to address this issue and ensure that this requirement is executed in accordance with the information we receive from the correctional facilities and the Social Security Administration.”
However, Medicare officials challenged the inspector general’s recommendation that they try to recoup the taxpayers’ money.
“There is no effective way of fully recovering these payments without first implementing the appropriate policies and procedures,” the agency said.
Investigators said CMS never checked the claims to see whether they were coming from inmates and didn’t give health care providers enough information.
“CMS did not provide sufficient and timely information to sponsors that would have allowed them to readily and accurately verify a beneficiary’s incarceration status and dates of incarceration,” the inspector general said.
The Medicare agency did not give health care providers any information on names or contact information for correctional facilities, which services would most likely be used by inmates, and the fact that some beneficiaries were incarcerated.
Without this data, the inspector general said, health care companies relied on public websites to try to determine whether their patients were in prison, an often hit-or-miss plan.
Wasteful payments in Medicare and Medicaid have long been targets of lawmakers trying to reduce spending and fiscal abuse in the government.
“We have a solemn responsibility to ensure that these programs have the resources they need to provide quality care and services, and part of that effort means cracking down on vulnerabilities in these programs that put taxpayer dollars at risk for waste, fraud and abuse,” said Senate Homeland Security and Governmental Affairs Committee Chairman Thomas R. Carper, Delaware Democrat.
“Americans who rely on Medicare and Medicaid expect Congress to work together to reduce waste and fraud,” said Sen. Tom Coburn of Oklahoma, the committee’s ranking Republican. “Improper payments divert scarce resources away from those most in need.”