Allegations of meaningful fraud that led to an indictment in Texas have now motivated a Congressional committee to invite the heads of the Centers for Medicare & Medicaid Services (CMS) and Office of Inspector General (OIG) to a briefing this March.
In separate letters to CMS Administrator Marilyn Tavenner (here) and Inspector General Daniel Levinson (here), the House of Representatives Committee on Energy and Commerce has made clear its intention to investigate how adequately CMS conducts its “screening of providers Medicare payments or other kinds of federal funds administered by CMS.”
The letters from Chairmen Fred Upton (R-MI), Joe Barton (R-TX), and Vice Chairman Michael C. Burgess, MD (R-MN), indicate that recent reports of meaningful use fraud in Texas have raised broader questions about the ability of CMS to detect fraud appropriately.
Joe White, who formerly served as the CFO of now defunct Texas hospitals operated by Tariq Mahmood, MD, is facing two counts — false statement and aggravated identify theft — related to Shelby Hospital’s attestation of its full-year demonstration of Stage 1 Meaningful Use for fiscal year 2012 following its initial 90-day reporting period in fiscal year 2011. White stands accused of using another employee’s identity to file attestation data unsupported by hospital’s actually EHR use.
Federal authorities are aiming to recoup the $785,655 paid to Shelby Regional from White, who also faces imprisonment of no more than five years and fine of $250,000 followed by no more than three years of probation for the first count and an imprisonment of two years and a fine of $250,000 followed one year of probation for the second, which would run consecutively to the first.
These revelations have prompted the Committee on Energy and Commerce to demand answers of Tavenner and Levinson. For Levinson, the questions are fewer:
• What recommendations has the HHS Office of Inspector General made to CMS relating to improving the screening of providers or fund recipients?• What actions is the HHS Office of Inspector General taking to examine how CMS could improve screening of providers or fund recipients?• What other federal databases could CMS use to screen providers or fund recipients?
For Tavenner, the committee is seeking answers to many more questions:
• What is the status of CMS efforts on predictive modeling used to develop provider characteristics?• What have been the accomplishments by Zone Program Integrity Contractors to improve provider screening over the last year?• What actions has CMS taken to screen providers using the General Systems Administration database on contract debarments, the Inspector General exclusions, and Social Security Administration master death file?• Has CMS coordinated with the FDDA on that agency’s debarment and disqualification lists?• What other federal databases could CMS use to screen providers or fund recipients?• How does CMS assure that the agency is alerted to credible fraud allegations concerning providers or fund recipients? What is CMS authority for stopping payments to a provider or recipient under investigation for fraud?• How many revocations of Medicare providers have occurred since January 1, 2004?
The committee makes no mention of either the meaningful use audits that CMS began conducting last year (which deal exclusively with the EHR Incentive Programs) or reports published by the Government Accountability Office (GOA)that repeatedly call attention to a lack of oversight on the part of CMS in its management of auditors.
The briefing is scheduled for March 12, 2014 at which time Congress expects answers to its questions.
