Misuse of funds weakens programs for vulnerable populations

Washington, D.C. — House Energy and Commerce Committee Chair Cathy McMorris Rodgers (R-WA), Subcommittee on Health Chair Brett Guthrie (R-KY), and Subcommittee on Oversight and Investigations Chair Morgan Griffith (R-VA), on behalf of the Health and Oversight Subcommittee Republicans, wrote to Department of Health and Human Services (HHS) Inspector General (IG) Christi Grimm and Centers for Medicare and Medicaid Services (CMS) Administrator Chiquita Brooks-LaSure regarding improper Medicaid payments, including a significant number of payments made to deceased enrollees.

KEY HHS IG LETTER EXCERPT: 

“Improper payments are widespread in Medicaid and have been estimated at $359.39 billion over the past five years. Such payments represent a significant misuse of funds that redirects payments away from providing essential care to our nation's most vulnerable populations.” 

The Chairs requested the following information by November 13, 2023: 

1. How does the HHS OIG plan to work with CMS to implement the recommendations made in the audit report [titled Virginia Made Capitation Payments to Medicaid Managed Care Organizations After Enrollees' Deaths] (A-03-22-00203)? 

2. Confirm if CMS advises states to check regularly the public Death Master File (DMF) to ensure beneficiaries have not been reported. 

3. Confirm if CMS advises states to check regularly the Public Assistance Reporting Information System (PARIS) to ensure that recipients of Medicaid are not receiving benefits in more than one state. 

4. As discussed in the hearing on April 18, 2023, will your office commit to reviewing current CMS practices and policies for interacting with states on eligibility determination systems, as well as identifying any areas for improvement and enhancement? 

CLICK HERE to read the full letter to HHS. 

KEY CMS LETTER EXCERPT: 

“Ensuring that Medicaid is only paying for individuals who are eligible for care should be a basic tenant of the program. However, it is clear that this simply has not been the case. A 2022 OIG audit [titled Prior Audits of Medicaid Eligibility Determinations in Four States Identified Millions of Beneficiaries Who Did Not or May Not Have Met Eligibility Requirements] (A-02-20-01018), reported that states routinely failed to document a beneficiary’s reported income, resources, citizenship, and even residency within the state from which the individual was seeking coverage from.” 

The Chairs asked for responses to questions, including the following by November 13, 2023:  

1. How does CMS plan to implement the recommendations made in the HHS OIG report (A-03-22-00203)? Does CMS agree or disagree with these recommendations? If CMS disagrees, what alternative approaches is the agency proposing to take to address the concerns? The recommendations are as follows: 

a. Refund unallowable capitation payments made to managed care organizations (MCOs). 

b. Identify and recover unallowable capitation payments made on behalf of deceased enrollees and repay the Federal share of amounts recovered. 

c. Continue to pursue development and implementation of an automated matching and eligibility update process. 

d. Implement additional supervisory review to ensure that State agency personnel completely and accurately update the State agency’s eligibility system based on information provided by the Department of Health’s Office of Vital Statistics. 

2. What steps has CMS taken to ensure oversight of and prevent Medicaid MCOs from receiving capitation payments after beneficiaries’ deaths, given that the OIG has written at least 14 reports on this issue? 

3. Does CMS advise states to check the Social Security Administration’s Death Master File (DMF)? If yes, please provide any supporting documentation. 

a. If CMS is advising states to regularly check the DMF, explain why deceased beneficiaries continue to receive payments? 

b. How often does CMS advise states to check the DMF? 

c. If CMS is not advising states to regularly check the DMF, explain why not. 

d. How is CMS working to improve the accuracy and timeliness of death data? 

e. What measures are being implemented to enhance the coordination and data sharing between CMS and state agencies? 

CLICK HERE to read the full letter to CMS.