U.S. Rep. James Langford (R-OK) expressed concern that the Centers for Medicare & Medicaid Services (CMS) Medicare Audit Contractor (MAC) program may be turning into a “bounty hunter process,” which makes providers serve auditor contractors that won’t give up until they find fraud.
Rep. Langford’s comments were not the harshest words heard from lawmakers when CMS Deputy Administrator for Program Integrity Peter Budetti testified before the House Subcommittee on government organization, efficiency and financial management on June 7; and CMS Deputy Director of Policy for Program Integrity Tom Doolittle testified before the House Energy and Commerce Subcommittee on oversight and investigations on June 8.
Rep. Cliff Stearns (R-FL) accused CMS of “being asleep at the wheel”—citing data that Zone Program Integrity Contractors (ZPICs) recover just 10 percent of overpayments they identify, and identify less than 1 percent of estimated fraud—and called into question the agency’s competency.
Rep. Kathy Castor (D-FL) accused the ZPICs of creating a “Wild West” atmosphere, without due process or checks-and-balances for providers. Rep. Michael Burgess (R-TX) questioned why contractors targeted legitimate providers with coding errors instead of pursing genuine cases of fraud, saying that it seemed as if CMS ignored the big problems to go after those, like coding errors, that are easy to correct.
Deputy Administrator Budetti told lawmakers that CMS agreed with much or their criticism, and that the agency is now focusing more efforts and funding on predictive analytics programs, the Fraud Protection System, and the Automated Provider Screening program.
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