House Oversight and Reform Committee Republicans sounded the alarm Tuesday about hundreds of billions of taxpayer dollars that have been improperly spent on one of the government’s largest and fastest-growing entitlement programs.
Rep. James Comer, the top Republican on the committee, sent a letter to the Centers for Medicare and Medicaid Services, which oversees Medicare and Medicaid, demanding answers about “rampant [and] improper” Medicaid payments.
Mr. Comer and the committee’s other Republicans are concerned that CMS’ own data shows that more than $57 billion was spent on improper Medicaid payments in fiscal 2019 and nearly $87 billion in fiscal 2020, accounting for one of every five Medicaid payments.
“Republicans on the committee have consistently sought to identify programs that have high levels of waste, fraud and abuse,” Mr. Comer wrote in the letter, which was obtained by The Washington Times.
In 2019, Medicaid represented nearly one-third of all improper payments made across the federal government.
“This is an unacceptable waste of American taxpayer dollars,” Mr. Comer wrote.
CMS officials did not respond to requests for comment.
Medicaid, which is funded by both states and the federal government, is the largest source of health coverage in the U.S. Representing one-sixth of the nation’s health care economy, the program covers low-income individuals, children, pregnant people and people with disabilities.
Since the implementation of Obamacare in 2010, Medicaid has grown considerably. Over the past decade, the program has been one of the federal government’s largest and fastest-growing entitlements. The health care law allowed states to expand Medicaid eligibility to residents whose household income is higher than the traditional cutoff, with the federal government picking up most of the tab. Twelve states have not signed on.
In 2018 alone, Medicaid covered 75 million individuals costing taxpayers more than $616 billion.
Mr. Comer and others say that while the number of Medicaid recipients has risen, accountability guidelines and fraud prevention efforts have not been updated.
For instance, since Medicaid is administered by both the federal governments and individual states, eligibility requirements differ widely by location. States are given wide latitude in setting their criteria, such as income thresholds, needed to qualify for the program.
Between 2015 and 2019, however, CMS did not audit the eligibility requirements being imposed by state governments. Mr. Comer said that lack of oversight likely has contributed to waste, fraud and abuse in the system.
“Failing to audit state Medicaid eligibility determinations in the midst of a dramatic expansion of Medicaid under Obamacare has more than tripled the amount of improper spending,” the lawmaker wrote. “The growth in improper payments is directly linked to states being incentivized to game the system by improperly classifying people as expansion enrollees to receive greater reimbursement rates.”
To crack down on the misuse of taxpayer money, Mr. Comer is requesting that CMS furnish the oversight committee with “all state-specific Medicaid improper payment rate information from 2015 to 2020.”