By Lindsay Toler
By Chad Garrison
By Brett Koshkin
By RFT Staff
By Lindsay Toler
By Riverfront Times
By Danny Wicentowski
By Pete Kotz
This slack oversight allows for glaring aberrations. In one instance, Texas' Medicaid dental program spent more on braces than the rest of the country's programs combined. But CMS only learned of it when TV reporter Byron Harris broke the story in Dallas.
Even more shocking is the case of New York state. Its centers for people with mental issues were charging the feds $5,000 per day per patient. Arizona, by comparison, charges $200 a day.
The reimbursements were based on a changing formula that CMS kept approving even as payments skyrocketed. New York's estimated overcharges: $15 billion.
This time, CMS discovered the state's gouging on its own. But six years later, it's still negotiating a remedy. CMS now plans to let New York phase out its overbilling, essentially allowing the state to steal a little less each month. (CMS officials declined to be interviewed for this story.)
More obvious improvements still elude the agency — even such basics as changing a beneficiary's Medicare number when theirs is stolen or used in a fraud. Others wonder why CMS hasn't mimicked the credit-card companies, which flag suspicious behavior within minutes.
"I sent my staffer to Chick-fil-A with my personal credit card to charge $100 of sandwiches for our office for lunch," says Burgess. "So I'm called off the floor of the House to answer a phone call from my credit-card company saying, 'Hey, someone is trying to charge $100 worth of sandwiches.' Why can't they do that?"
Obamacare has allocated $100 million to CMS to create a similar system, employing data analytics to mine for suspicious claims. The new proactive stance includes a spiffy command center in Baltimore linked to field agents. In its first full year, the system identified or prevented $115 million in fraud.
But as Burgess notes, Obamacare provided CMS with "seven new tools" to fight fraud. Four years after the law passed, CMS has managed to enact just one.
"At this rate, some point before my natural death, maybe we'll have done half of them," says the congressman.
Though most everyone agrees that the government is moving in the right direction, $100 billion continues to walk out the door each year.
"This is a lucrative business, and business is good," says Feinwachs. "The only problem is that you and I are funding it."