Medicare Faces Fraud on Another Front

Reports have recently revealed that Medicare prescription drug supplements are not being watched very carefully.  In fact, there is a fraud prevention program that is supposed to be in effect to deal with the prescription drug coverage offered by private insurance companies. 

The Government Accountability Office holds CMS responsible for monitoring and auditing the $39 billion prescription drug programs.  That is a great deal of money that could easily be misused.  The GAO examined five plans that are unnamed and created a report detailing the shortcomings regarding what CMS is responsible for. 

Some of the oversight responsibilities that have not been adhered to by CMS include establishing training programs for employees so that they can recognize fraud and misuse of relevant laws.  Only two of the five programs have established such training. 

CMS states that though they did not have the training in place, the programs did establish written standards for detection and prevention of fraud and waste.  The GAO has strongly suggested that CMS should conduct audits of the prescription drug programs.

CMS says that they have asked the programs to produce self-assessments – (remember the fox watching the hen house, again?) – and said they would use the self-assessment surveys in place of audits for now.  They said that they are focusing on complaints, especially since their audit budget was capped at $720 million, stating that this restricted amount makes it difficult, if not impossible, to conduct proper auditing.

This attitude toward auditing fraud, coupled with the fact that CMS has not developed even a streamlined auditing system, might be saving Medicare some tightly budgeted money in the short term, but the billions that are being taken out of Medicare while officials are ignoring the problem, could be saving the country and its Medicare beneficiaries billions.  This might be enough to eliminate some of the unaffordable and superfluous supplemental programs and create a Medicare system that is affordable and works for everyone. 

Filed under: General-Medicare

Tags: CMS, General-Medicare, medicare audits, medicare fraud