Committee Seeks Update from CMS Administrator on Implementation of Efforts to Protect Medicare Funds

September 6, 2013

WASHINGTON, DC – House Energy and Commerce Committee leaders yesterday sent a letter to Centers for Medicaid and Medicare Services (CMS) Administrator Marilyn Tavenner requesting an update on the agency’s efforts to reform the Medicare Secondary Payer (MSP) program. The program, which was created to protect Medicare funds by ensuring CMS is reimbursed for claims the agency is not primarily responsible for paying, has been marked by inefficiencies and delays.

A June 22, 2011, Subcommittee on Oversight and Investigations hearing revealed the MSP program was plagued by inefficiencies that led to costly delays for businesses, health plans and, ultimately, Medicare beneficiaries. To address these issues, the committee passed and President Obama signed the Strengthening Medicare and Repaying Taxpayers Act (SMART Act), authored by Oversight and Investigations Subcommittee Chairman Tim Murphy (R-PA).

Congress enacted the SMART Act so seniors owed settlements aren’t waiting years for CMS to resolve old medical billing cases, needlessly risking their Social Security checks and Medicare coverage in the process. Passage of the SMART Act was just half the fight. Now the agency must demonstrate to the Committee that they are implementing the SMART Act swiftly, transparently, and according to congressional intent,” said Murphy.

The committee is seeking information from CMS to better understand why certain timeframes for implementing the SMART Act have not been met and why costly recovery practices continue. In addition, the committee is requesting an update on where CMS stands in eliminating the use of Medicare beneficiaries’ Social Security Numbers and Health Insurance Claims Numbers in reporting, and what alternative methods are being considered.

In the letter to Administrator Tavenner, the leaders wrote, “While it is our understanding that CMS has made some progress in implementing the SMART Act and improvements to the MSP program, some challenges remain. In August 2011, CMS announced that it would only pursue those claims with a recovery value of $300 or more in certain liability insurance cases. However, it is our understanding that CMS continues to pursue claims below the $300 threshold. In addition, CMS has not promulgated certain regulations and rules required under the SMART Act by the deadlines specified in the law.”

The letter was signed by Subcommittee Chairman Murphy, Chairman Emeritus Joe Barton (R-TX), Vice Chairman Marsha Blackburn (R-TN), and Michael C. Burgess, M.D. (R-TX), Vice Chairman of the Health and Oversight and Investigations Subcommittees.

For a copy of the letter, click here.

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