Washington, D.C. - Congressman Michael C. Burgess, M.D. (R-TX), Co-Chair of the GOP Doctors Caucus, joined Members of Energy and Commerce, Ways and Means, and Oversight Committees as well as the GOP Doctors Caucus in sending a letter to the Inspector General of the U.S. Department of Health and Human Services and the Administrator of the Centers for Medicare and Medicaid Services. Members expressed their concern and requested a briefing by March 20, 2024, regarding a year long Medicare fraud scheme involving catheter billing which was estimated to cost $3 billion.
Members highlighted the failure to detect fraud schemes threatens the fiscal integrity of Medicare, undermines the public’s trust, and risks the well-being of beneficiaries.
Click HERE for the full letter.
On the concern of the Medicare fraud scheme that has been estimated to cost $3 billion:
We write to express our concern and request a briefing on an issue that has recently been highlighted in public reporting—a large-scale, year-long Medicare fraud scheme involving catheter billing. Public reporting estimates the cost of fraud from this scheme to be at $2 billion, but discussions with stakeholders suggest the dollar figure may be closer to $3 billion. As the Committees with oversight responsibility for Medicare, and Chairs of the GOP Doctors’ Caucus, we are alarmed that such blatant fraud may have gone undetected for over a year. If so, the failure to detect such fraud threatens the fiscal integrity of Medicare, undermines the public’s trust, and risks the well-being of beneficiaries.
On the catheter billing fraud affecting over 450,000 Medicare beneficiaries and on the request for a briefing no later than March 20, 2024:
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.
Moreover, while we understand that the lack of clear communication from CMS and HHS OIG to patients, health care providers, Congress, and the public may be a result of the agencies’ desire to protect an ongoing investigation, the lack of information may force victims to seek information through unofficial channels, such as social media platforms. It is unacceptable that beneficiaries have to rely on platforms like Facebook to share and obtain information on potential Medicare fraud.
We request separate briefings from CMS and HHS OIG no later than March 20, 2024, to
better understand the steps being taken to address this fraud and prevent its reoccurrence.
Members joining Congressman Burgess in 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), and GOP Doctors Caucus Co-Chair Greg Murphy, M.D. (R-NC), and Co-Chair Brad Wenstrup, D.P.M. (R-OH).
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.
In 2016, Republican Members of Congress wrote to then Centers for Medicare and Medicaid Services Acting Administrator Andy Slavitt to express concern over the rise in Medicare's improper payments.
Under the Biden administration, Medicare improper payments have reached an estimated total of $87.72 billion.
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