O&I Subcommittee Holds Hearing with State Medicaid Directors as Part of Committee’s Extensive Probe into Medicaid Programs Nationwide
WASHINGTON, D.C. – Today, Congressman John Joyce, M.D. (PA-13), Chairman of the Subcommittee on Oversight and Investigations, led a hearing titled State Medicaid Program Integrity: Examining Fraud Risks and Oversight Deficiencies.
“Let me be clear: fraud is not isolated to these states. As we discussed in two previous hearings before this Subcommittee, Medicaid fraud is a real problem. It happens in every single state, red and blue, and has been harming patients and draining taxpayer resources for decades,” said Chairman Joyce. “It is no longer sufficient to do the bare minimum. States must rise to the occasion and tackle fraud head-on. Our Medicaid program and the patients that rely on it to be healthy depend on it.”
Watch the full hearing here.
Below are key excerpts from today’s hearing:
Chairman Brett Guthrie (KY-02): “The Committee requested documents and information from your agency on March 3rd, including all audits related to fraud, waste, and abuse in the state’s Medicaid programs—including audits completed by third party contract auditors from January 1, 2021, to present. [...] Based on the information that has been provided to the Committee, we know that California has conducted such audits, but the committee did not receive a single audit document from California until 7 p.m. last night. Do you believe that providing more than 1,300 pages of documents on the eve of a hearing is fair to this committee?” Mr. Sadwith: “Thank you, Chairman... and I acknowledge the frustration.... we have been working with Committee staff to produce information and address the questions, including the list of 26,000 audits and investigations that we have conducted over the past five years. Last night, we provided some audits related to transportation and mental health that the committee had indicated were—” Chairman Guthrie: “There were also other [documents] that we requested... will you commit to providing what we’ve requested to this Committee? In a timely manner?” Mr. Sadwith: “Thank you, Chairman. There are ongoing law enforcement investigations that would be impacted by those specific audits that were requested. We’re happy to provide the appropriate information at the appropriate time.” Chairman Guthrie: “It just seems unfair to us to prepare for a hearing that you send everything to [us at] 7 p.m. last night. It almost seems like that was intentional.”
Congressman Gary Palmer (AL-06): “Mr. Connolly, CMS asks that you revalidate all providers in the 14 high risk Medicaid programs, with nearly 5,600 providers. After the initial revalidation, your office reported it disenrolled more than 3,400 providers; that’s 60 percent of those enrolled. However, last week, it appears your agency restored the billing privileges for over 2,100 that submitted the appeals. What’s going on with this revalidation process, and how are you making sure that providers who are restored pending appeal are filing legitimate claims in the meantime?” Mr. Connolly: “All of those services are subject to enhanced pre-payment review and all of the high-risk designation requirements that are associated with it.” Congressman Palmer: “It’s also been reported that many of the providers that were disenrolled had been flagged by your agency before...in other words, there was some suspicion. Is that true? Had they been flagged before?” Mr. Connolly: “...I’d have to confirm the details of that for you.”
Congressman Michael Rulli (OH-06): “What was exciting for me, Director [Partika], is when I realized that we had the Attorney General and the Auditor working with your office, because, you know what? In life, sometimes we’re not perfect. And the wonderful story about America is that—when you look at our history—we correct our wrongs, like we do in Ohio. We’re not all full of ourselves that we’d say we’re perfect in the state of Ohio, we know that we’re flawed. But I like the idea that the three branches over there—you got the Attorney General’s office, you got the Ohio Auditor, and then you have [the state Medicaid director]—that are all working together to make it better. When you’re fourth in the country for Medicaid expansion, we want to make sure our people have their services.”
