EXCLUSIVE: Republicans From Both Chambers Demand Answers Over Improper Medicaid Payments

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Brianna Lyman News and Commentary Writer
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A group of Republicans from both houses of Congress sent a letter Wednesday to the Centers for Medicare and Medicaid Services (CMS) demanding the organization detail its plan to address improper payments in Medicaid, according to a copy of the letter exclusively obtained by the Daily Caller.

Spearheaded by Republican Wisconsin Sen. Ron Johnson and Kentucky Rep. James Comer, the letter is joined by 18 other Republicans demanding insight into how CMS is handling “improper payments” that have reportedly increased more than 400%.

“Since the passage of Obamacare, Medicaid’s improper payments have increased 400%, and the rate of improper payments is more than three times the government-wide rate. Unfortunately, there appears to be very little interest on the part of Democrats in Congress to investigate and conduct oversight of this significant financial mismanagement,” Johnson said in an exclusive statement to the Daily Caller. “This is the problem that must be addressed to ensure the financial stability of Medicaid so it is available for those who truly need it.”

The letter claims the improper payments in the Medicaid program could total “more than $100 billion annually.”

“This alarming amount threatens the viability of a program designed for Americans in need,” the letter reads. “We write seeking additional information on what safeguards CMS has in place to address improper payments in the Medicaid program.”

Medicaid made $57.36 billion in improper payments during fiscal year 2019 and $86.49 billion in fiscal year 2020, according to CMS data. The improper payment rates were 14.9% and 21.36% respectively. CMS is required by the Social Security Act to recover improper payments exceeding three percent.

(DAILY CALLER OBTAINED) — … by Henry Rodgers


By fiscal year 2020, “more than one out of every five Medicaid payments were improper,” the letter states.

The letter says a majority of the improper payments were a result of “eligibility errors, administrative oversights, or outright fraud.”

“These staggering rates of improper payments in Medicaid programs are inexcusable,” the letter reads. “As CMS data underscores, these improper payments threaten the integrity of the Medicaid program.” (RELATED: Inspector General: COVID Relief Programs Were ‘Invitation’ To Fraudsters)

The letter calls on the CMS to provide data on how improper payments rates and eligibility are determined, what protocols are in place in each state to validate the improper payment rate, a list of CMS’s efforts “to recover the hundreds of billions of dollars in improper Medicaid payments” and the “estimated improper payment rate” as a result of Medicaid’s COVID-19 related expansion.

CMS uses the Comprehensive Error Rate Testing program to determine the improper payment rate, according to CMS. The program “cites improper payments in accordance with payment policies on any claim” that was incorrectly paid or paid in an incorrect amount. CMS claims most improper payments are not indicative of fraud but rather are “caused by improper or inadequate documentation.”

During the pandemic, CMS “exercised its enforcement discretion and implemented a temporary policy to suspend all improper payment related to engagement/communications and data requests to providers and state agencies from CMS and its contractors between March 2020 and August 2020,” according to Medicaid.gov.

CMS failed to thoroughly respond to a March 2019 letter from Republican Pennsylvania Sen. Pat Toomey and Republican Iowa Sen. Chuck Grassley, along with a December 2020 letter spearheaded by Johnson regarding the same issues.