Washington, D.C. — After public reports of a large-scale, year-long Medicare fraud scheme involving catheter billing, leaders from the Energy and Commerce, Ways and Means, and Oversight and Accountability committees, along with GOP Doctors Caucus Co-Chairs, are seeking a briefing from Department of Health and Human Services (HHS) Inspector General (IG) Christi Grimm and Centers for Medicare and Medicaid Services (CMS) Administrator Chiquita Brooks-LaSure.

In a new letter, the lawmakers request briefings from the HHS IG and CMS by March 20, 2024, regarding what steps are being taken to address this reported fraud and prevent its reoccurrence. 

KEY LETTER EXCERPTS:

“It is imperative that the U.S. Department of Health and Human Services Office of the Inspector General take immediate action to reduce improper payments and ensure that taxpayer dollars are directed towards the care of our senior citizens whom Medicare is intended to serve.

“Based on the information that is publicly known to date, the scale of the alleged catheter billing fraud, affecting over 450,000 Medicare beneficiaries, may represent a significant failure by CMS and HHS OIG. This dramatic, multifold increase in catheter billing—from just a handful of companies—should have been quickly identified and addressed. If public reports about the apparent ease with which this fraud was perpetrated are accurate, they raise questions about the efficacy of current CMS and the HHS OIG fraud detection and prevention measures. In addition, there are stakeholder concerns that a similar increase in fraud has occurred in diabetes supplies, and that this increase may be evidence of a new fraud against the Medicare program.”

BACKGROUND:

• Public reporting estimates the cost of fraud from this scheme to be at least $2 billion.
• However, discussions between committee staff and stakeholders suggest the dollar figure may be closer to $3 billion.
• During the Trump administration, Medicare improper payments were reduced by billions per year.
• In the years since President Biden took office in January 2021, however, improper payments have increased dramatically.
• House Republicans have long raised the alarm about the prevalence of improper and fraudulent payments in the Medicare and Medicaid programs.
• In 2016, Republican Members of Congress wrote to then Centers for Medicare and Medicaid Services (“CMS”) Acting Administrator Andy Slavitt to express concern over the rise in Medicare's improper payments.
• Under the Biden administration, Medicare improper payments have an estimated total of $87.72 billion.

Members signing the letter include:

• Energy and Commerce:
• Full Committee Chair Cathy McMorris Rodgers (R-WA)
• Health Subcommittee Chair Brett Guthrie (R-KY)
• Oversight and Investigations Subcommittee Chair Morgan Griffith (R-VA)
• Ways and Means Committee:
• Full Committee Chair Jason Smith (R-MO)
• Health Subcommittee Chair Vern Buchanan (R-FL)
• Oversight Subcommittee Chair David Schweikert (R-AZ)
• Oversight and Accountability Committee:
• Full Committee Chair James Comer (R-KY)
• Health Care and Financial Services Subcommittee Chair Lisa McClain (R-MI)
• GOP Doctors Caucus
• Co-Chair Greg Murphy, M.D. (R-NC)
• Co-Chair Michael Burgess, M.D. (R-TX)
• Co-Chair Brad Wenstrup, D.P.M. (R-OH)

CLICK HERE to read the full letter.