Advocacy / Politics

Keeping the Promise: How Better Managing Medicare Can Protect Seniors

On Tuesday, March 4th, the House Energy and Commerce Health Subcommittee held a hearing entitled, “Keeping the Promise: How Better Managing Medicare Can Protect Seniors.”  The Subcommittee intently focused on the Centers for Medicare and Medicaid Services’ (CMS) oversight of the Medicare program.  CMS is the government agency charged with managing all aspects of Medicare – a highly complex program that is on an unstable fiscal path.

Prior to the hearing, AMAC submitted a policy paper to the Subcommittee – sharing our assessment of CMS’ management of Medicare and highlighting areas that CMS could work to strengthen the Medicare program as a whole.  AMAC’s policy paper identified three specific steps CMS could take to enhance its oversight of Medicare, including CMS’ exertion of more effective control over managing contractors, the modernization of its business model and the Medicare program, and the reduction of program vulnerabilities by fighting waste, fraud, and abuse.  The Subcommittee made many of these issues focal points of the hearing.

Also in conjunction with the hearing, the Department of Health and Human Services released two new reports.  One report found that

CMS has not: leveraged contractor-reported data to improve oversight; investigated variation in data across contractors to determine underlying causes, especially when it is not explained by the size or geographical jurisdiction of contractors; addressed underperforming contractors timely and required corrective action for all performance standards that were not met; or shared information with beneficiaries and other stakeholders that could assist anti fraud efforts.[1]

While AMAC understands that Medicare is a massive government program to manage, we remain concerned that CMS has not taken appropriate action to respond to reported contractor problems.  These contractors assist in identifying and eliminating improper payments and fraud, yet many of them have contributed to confusion within the Medicare program among physicians and have even had financial ties to claims processors.[2]  CMS has done very little to address the conflicts of interest that exist among their contractors.

Contractors continue to contribute to one of the most prominent issues plaguing the Medicare program: waste, fraud, and abuse.  AMAC’s policy paper strongly urges CMS to redirect its attention, resources, and efforts to protecting the billions of taxpayer dollars that are lost as a result of waste and fraud each year.  By tightening their focus on curtailing fraudulent payments, CMS could certainly prolong the chronic life of the Medicare program.

Still, the fact remains – as was revealed by Representative Phil Gingrey’s (R-GA) questioning of the witnesses – that underlying all of Medicare’s problems is a desperate need for real, structural reform and modernization.  When asked by Rep. Gingrey, “If we could eliminate every dime of waste, fraud, and abuse… do you think that that would save Medicare for future generations?,” witnesses from the Government Accountability Office, Kathleen King and James Cosgrove, promptly replied, “no.”

Subcommittee Chairman Joe Pitts (R-PA) expanded on Rep. Gingrey’s line of thought, adding,

While reducing waste, fraud, and abuse – and managing the program more effectively – should be an administration priority, that alone is not enough to address Medicare’s spending problem.  However, critics are correct that a Congressional solution is needed.  We must do everything in our power to safeguard the money in the Trust Fund, until such time as Congress accepts its responsibility to make structural changes to save the program for the millions who depend on it.

AMAC also purports that Medicare must undergo substantial reform if Congress’ promise to provide access to health care to seniors and those with disabilities will be kept.  AMAC offers policy suggestions in the document given to the Subcommittee for how Congress could go about reforming the program – using the popular, market-based Medicare Advantage and Medicare Part D prescription drug programs as a basis for reform.

Congress must unite to achieve Medicare reform and work together to generate a palatable solution if Medicare is going to find itself on a more sustainable path.  As it is now, trustees of the Medicare Trust Fund project that Medicare could be rendered insolvent by 2026 – a startling prognosis for this program and the millions of mature Americans and seniors who depend on it.  AMAC continues to bring this issue and others to the attention of lawmakers in Congress, and we look forward to engaging with them on future issues of importance to our members as our presence in Washington grows.

[1] Vito, Robert.  Written Testimony for House Energy and Commerce Health Subcommittee hearing: “Keeping the Promise: How Better Managing Medicare Can Protect Seniors.” Regional Inspector General for Evaluations and Inspections, Office of Inspector General, Department of Health and Human Services. March 4, 2014.

[2] Cheung-Lavrivee, Karen. “OIG: Contractor Conflicts of Interest Weaken Medicare.” Fierce Healthcare. July 11, 2012.

If You Enjoy Articles Like This - Subscribe to the AMAC Daily Newsletter
and Download the AMAC News App

Sign Up Today Download

If You Enjoy Articles Like This - Subscribe to the AMAC Daily Newsletter!

Notify of
1 Comment
Oldest Most Voted
Inline Feedbacks
View all comments
8 years ago

Good, informative article for the membership of AMAC to read. Nicely done. The levels of waste, fraud and abuse have been well documented for several years and communicated a number of times to CMS management. Unfortunately, aside from a collective shrug from CMS management and a passing acknowledgement from several concerned members of Congress, nothing much has been done to make real, substantial changes to the program. If we ever get a Congress and President in place that is truly committed to saving Medicare, aside from lip service, perhaps we can finally enact a number of these managerial changes to Medicare to improve its chances of future solvency.

Would love your thoughts, please comment.x