1 in 5 Medicaid payments improper, and these lawmakers want to know why

Fox Business Flash top headlines for September 1

Check out what’s clicking on FoxBusiness.com.

Improper payments by Medicaid – a federal-state health insurance program for the poor – surpass the number of improper payments for all other federal programs, and a group of lawmakers is pushing for more information. 

Republican members of the House Oversight and Reform Committee wrote Centers for Medicare and Medicaid Services (CMS) Administrator Chiquita Brooks-LaSure seeking answers for the improper payments that have spanned multiple administrations. 

The waste in Medicaid is not a Biden administration problem. In the fiscal year 2020, a total of $86 billion – or 21% of all Medicaid payments – were improper, according to CMS data. That’s up from fiscal year 2020 when Medicaid made $57 billion in improper payments, or14.9 percent.


The Government Accountability Office has categorized Medicaid as a "high risk" program and has said Medicaid has made a significant share of the improper payments to ineligible medical providers that included those with suspended medical licenses.

"According to the Government Accountability Office (GAO), there is no program with more rampant improper payments than the Medicaid program," says the Republicans' letter led by Reps. James Comer of Kentucky and Jody Hice of Georgia and joined by 18 other GOP House members. 

"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," the GOP letter continued. "Unfortunately, it appears there are no plans to prevent improper payments from continuing to grow, particularly since Medicaid has been designated by GAO as a high-risk area for the past 18 years."


The House Republicans, as a minority, only have the power to request and cannot subpoena information from federal agencies. The GOP lawmakers, in the Aug. 17 letter, requested all state-specific Medicaid improper payment rate information from 2015 to 2020 for the committee to conduct oversight over the program’s waste. They gave CMS a deadline of Aug. 31 to respond. 

A CMS spokesperson told FOX Business the agency launched the Medicaid Program Integrity Strategy for fiscal years 2019-2023 that includes stronger audits and oversight functions, and also provided guidance to states on accurate eligibility determinations. The spokesperson added that CMS is releasing a series of tools and webinars that address many of the errors that cause improper payments. 

"While the responsibility for making proper payments in Medicaid primarily lies with the states, CMS plays a significant role in supporting state efforts to meet high program standards," the spokesperson continued. "CMS uses the Payment Error Rate Measurement (PERM) program to estimate national improper payment rates in Medicaid. The improper payment rates are based on reviews of the fee-for-service, managed care, and eligibility components of Medicaid in the fiscal year under review. CMS measures Medicaid improper payment rates using three 17-state cycles so that each state is reviewed once every three years."

A House Republican staffer with the Oversight Committee said late last week that CMS had not yet responded to the committee members. 


The GOP letter said an audit is overdue.

"These abuses are even more concerning since from 2015 to 2019 CMS did not audit states’ Medicaid eligibility determinations. While CMS began working on an audit during  2020, it was delayed due to the COVID-19 pandemic," the letter says. "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."

Source: Read Full Article