Dear Inspector General Levinson and Dr. Budetti:
As a follow up to the March 2, 2011, hearing “Preventing Health Care Fraud: New Tools and Approaches to Combat Old Challenges," and in our roles as Chairman and Ranking Member of the Finance Committee, we would like to request that you begin providing our offices with quarterly reports on how each of your offices are utilizing the resources allocated for fighting waste, fraud, and abuse and the results of the use of those resources. This will better enable us to help advocate for additional resources to support your efforts in addition to providing us important oversight information about how the resources already allocated to your offices are being used. Specifically, the following are examples of the type of information requested:
Office of the Inspector General
* The amount of funds obligated each quarter from the overall current fiscal year budget and to which areas those funds have been specifically allocated (e.g., investigations, audits, evaluations, training).
* The number of exclusions initiated by actions taken by the OIG, the total number of exclusions entered into the OIG exclusion database (e.g., license revocations and other actions which did not require any specific OIG initiation), and the number of providers that have been excluded from Medicaid and CHIP as a result of an exclusion from Medicare.
* The number of individual investigations opened and number of individual investigations closed during that quarter and information regarding the disposition of those investigations (i.e., case closed with no action, conviction, recoupment of funds).
* The number of cases referred to OIG by other sources (such as CMS) and a breakdown of those by referral source.
* Total number of calls to the OIG Hotline and number of those calls which resulted in actual cases.
* Number of Corporate Integrity Agreements (CIAs) entered into and closed as well as a description of any actions taken regarding breaches of CIAs.
* Number of civil monetary penalty or other administrative actions initiated during that quarter and the sanctions or other steps taken ancillary to those actions.
* For activities initiated by the HEAT program, a breakdown by city of statistics for investigations opened/closed and enforcement results (i.e., indictments, convictions, recoveries) for each of those cities.
Centers for Medicare & Medicaid Services
* The amount of funds obligated each quarter from the overall current fiscal year budget and to which areas those funds have been specifically allocated (e.g., contractor work, data analysis, field office initiatives, provider education).
* Beginning with the March 25, 2011 implementation of the new provider screening provisions, a breakdown by industry segment (e.g., home health, durable medical equipment, physician) for each month showing how many applications were screened, the number of providers/suppliers flagged using the new screening tools, and the number of providers/suppliers denied billing numbers as a result of that process.
* The number of suspensions currently in place, any new suspensions initiated, who initiated the suspension (CMS or law enforcement), the number and length of suspensions extended, actions taken as a result of any suspensions that were lifted (i.e., was the case referred for prosecution, administrative settlement or was there an overpayment determination made).
* Information pertaining to any provider enrollment moratorium, including the type of provider, the geographic scope, the length of moratorium, and the level of access to the services/supplies in question during the moratorium.
* An update on the status of ongoing demonstration projects that utilize technology (including, but not limited to, predictive analytics) to prevent and/or identify fraudulent claim submission.
* The total number of referrals made by CMS’ contractors (RACs, MACs, ZPICs/PSCs and MICs) to law enforcement, the length of time from referral until law enforcement took action on the referral and what the final action was on the referral.
* Total number of administrative actions (such as overpayment determinations, sanctions or civil monetary penalties) imposed by CMS, the duration and/or dollar value of those actions and resolution of those actions (e.g., amount paid, corrective action plan submitted).
* Total number of cases or administrative actions initiated or referred as a result of information provided through the Florida fraud hotline, 1-800-MEDICARE, Senior Medicare Patrol and/or the CMS field offices.
* Dollar amount of Recovery Audit Contractor (RAC) recoveries for that quarter by each RAC region, as well as a breakdown of RAC administrative expenses versus recoveries. Include related appeals numbers and costs that are attributable to RAC overpayment determinations. Also include a breakdown between RACs operating in Medicare fee-for-service, Medicare Part C, Medicare Part D, and Medicaid (as those RACs become operational).
* An explanation of any operational issues or delays experienced during that quarter with respect to implementing provisions of the Affordable Care Act and CMS’ plan of action for addressing those delays.
* We would like to receive the first of these quarterly updates by May 20, 2011, reporting on the first calendar quarter of 2011. Each subsequent report should be published approximately six weeks after the end of the quarter. To compliment these published reports, agency staff should brief relevant committee staff when necessary. If you have any questions regarding this request, please contact Committee staff at (202) 224-4515.
Sincerely, Max Baucus Chairman, Orrin Hatch Ranking Member
Source: Ranking Member’s News
