Dems Blast CMS's Oversight Of Medicare Advantage Plans

Democrats at a joint hearing of two House Ways and Means Subcommittees offered harsh criticism of how the Centers for Medicare and Medicaid Services has failed to meet requirements regarding audits of Medicare Advantage plans, and raised the specter of delegating such authority to the states instead.

In opening the joint hearing of the subcommittees on Health and Oversight, Health Subcommittee Chairman Pete Stark, D-Calif., opined that the hearing would be more appropriately seen as being on the lack of oversight of CMS and Medicare Advantage programs.

“The focus of this hearing is on private government contractors receiving billions of dollars to administer a government program with no oversight or control by the administration,” he said.

The basis of the hearing was reported from the Government Accountability Office, which found that CMS had failed to meet the minimum requirements set out for it to conduct audits of Medicare Advantage plans.

“GAO reports that CMS audits only a small percentage of the bids that plans submit-even though the law requires them to audit one-third,” Stark said. “What’s even more disturbing is that while they have failed to meet the terms of the law, even the small percentage they review reveals large discrepancies with millions of dollars in lost benefits and incorrect accounting. The few audits that are actually performed only show us what plans offer, not the benefits that they actually deliver. In a $73 billion program, we have no idea what benefits are being delivered. That’s not good government, it’s dereliction of duty.”

Among those criticizing the CMS was Rep. Rahm Emanuel, D-Ill., who said Congress faces the choice between having CMS “do what it is supposed to” or potentially delegating greater authority to the states to oversee Medicare Advantage plans. “Somebody has got to do the policing,” he said. Emanuel also paraphrased President Abraham Lincoln’s remark to a slow acting general with the comment, “If you’re not using your army, may we borrow it?”

Otherwise, Emanuel warned he “would be more than willing” to give the states greater authority to regulate Medicare Advantage plans.

Representing CMS at the hearing, Chief Financial Officer Timothy Hill said, “We are going to use our army,” and would be taking a far more active role in ensuring that all of the requirements for CMS’ audits of Medicare Advantage programs will be met going forward.

Rep. Earl Pomeroy, D-N.D., a former state insurance commissioner, then suggested CMS did not even have the resources to fulfill its duties, saying “you don’t even have an army” capable of fully auditing plans.