When federal investigators visited the address listed for a Medicare provider last December, they instead found a fast food restaurant.
That’s not unusual for federal investigators dealing with the Centers for Medicare and Medicaid Services, the section of the Department of Health and Human Services that oversees Medicare and made $60 billion in improper payments in fiscal year 2014.
That $60 billion accounted for more than 10 percent of everything spent on health care services by the federal government in 2014, according to the Government Accountability Office.
Medicare is the federal government’s primary health care program for Americans 65 and older. The new GAO report makes it clear why the congressional watchdog lists Medicare as a “high-risk” program, year after year.
One in five Medicare providers, like the one that turned out to be a fast food chain location, is using a potentially “ineligible” address, the GAO found. Such addresses are red flags Medicare fraud and abuse.
CMS requires providers to list their actual practice location, but a GAO dive into 2013 data found 23,400 of 105,234 locations are “potentially ineligible.” The report suggested there will be more such addresses because in 2014 CMS “reduced the amount of independent verification conducted by contractors, thereby increasing the programs’ vulnerability to potential fraud.”
The screening software used by CMS can’t detect potentially ineligible addresses like post office boxes, vacant lots and fast food franchises.
That isn’t the only problem GAO investigators found with CMS’ oversight of one of the federal government’s most expensive programs.
Federal investigators also found officials failed to remove 147 physicians who failed to tell CMS that they had been found guilty by a state medical board of criminal activity. It took CMS months longer than it should have to remove some of those doctors from the system, and CMS “never removed” others, the GAO found.
Here are 10 things the federal government could pay for with the $60 billion CMS misspent in 2014.
- Repair the 18,000 dams in the U.S. considered high-hazard or deficient, three times over, according to the American Society of Civil Engineers.
- Fund the Marine Corps’ entire budget for two and a half years.
- Finance universal preschool for all three and 4-year-olds for 10 months, according to figures from the National Institute for Early Education Research.
- Educate military veterans through the GI bill for six years.
- Offer two-year college tuition in the U.S. for 10 years for free, at least, according to President Obama.
- End world hunger for at least two years, according to the United Nations.
- Give $188 back to every person living in the United States.
- Build 100 Long Range Strike Bombers, according to the Air Force.
- Pay the interest on the federal debt for three months in fiscal year 2015.
- Refund people who paid the estate tax, the estate and trust income tax, unemployment insurance tax, and the gift tax for a year, according to 2014 IRS revenue figures.
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