Bipartisan Group of Senators Respond to Inspector General Report on Medicare Services to Ineligible Beneficiaries

WASHINGTON – Today, Sens. Tom Carper (D-Del.), Tom Coburn (R-Okla.), Max Baucus (D-Mont.) and Orrin Hatch (R-Utah) responded to two recent Department of Health and Human Service (HHS) Office of the Inspector General (OIG) reports that detail millions of dollars spent on Medicare services for ineligible beneficiaries, including people who were incarcerated or unlawfully present in the United States.  

The first report, Medicare Improperly Paid Providers Millions of Dollars for Incarcerated Beneficiaries Who Received Services during 2009 through 2011 (A-07-12-01113), found that the Centers for Medicare and Medicaid Services (CMS) paid $33.6 million in claims to medical providers for services to more than 11,000 beneficiaries who were incarcerated between the years 2009 and 2011. Furthermore, the second report, Medicare Improperly Paid Providers Millions of Dollars for Unlawfully Present Beneficiaries Who Received Services during 2009 through 2011 (A-07-12-01116) , found that CMS also paid $91.6 million for Medicare services for 2,575 beneficiaries who were not lawfully present in the United States.  Under eligibility rules, Medicare beneficiaries, with few exceptions, cannot be incarcerated and must be legal residents of the United States.  

Following the OIG’s investigation, Medicare officials made arrangements to quickly to fix the problems described in the report by automatically reviewing all past payments for incarceration and legal residency and establishing a process for recovering the funds. The agency says the problem will be corrected by April of this year. 

“We have made important strides in recent years in our efforts to root out waste, fraud and abuse within Medicare, but these reports underscore that there’s still more to do to address this issue,” said Sen. Carper. “Paying more than $120 million in Medicare funds for health care services for people who are clearly not eligible for Medicare benefits is unacceptable, and these improper payments must be recovered. That being said, I commend Medicare officials for the actions they have taken to fix the problems identified by the inspector general, and look forward to seeing a specific plan to prevent these types of mistakes from happening in the first place. It should remain a top priority of Medicare officials to ensure taxpayer dollars aren’t spent on ineligible beneficiaries while also protecting both present and future Medicare and Medicaid beneficiaries’ access to quality care. I will continue to work with the Administration as it pursues programs to improve efficiency and better protect taxpayer dollars and these critical programs that millions of Americans depend on.” 

“The Inspector General’s reports are concerning: they reveal Medicare’s current bill-paying practices have not prevented tens of millions of taxpayer dollars from inaccurately going to pay for illegal aliens and criminals,” said Sen. Coburn. “Medicare officials have said they will modify their systems to ensure such egregious payments are not perpetuated in the future, and I look forward to ensuring enhanced screening provisions adequately prevent the loss of precious taxpayer dollars. The Inspector General’s report serves as a reminder that oversight of often-overlooked technical issues like data-sharing is important and has a very real impact on the efficiency of Medicare and the taxpayers who pay for it.”

“This is the American people’s money on the line so we must ensure not one single taxpayer dollar goes to waste.  This report shows we must continue our efforts to weed out, stop and recover improper payments,” said Sen. Baucus. “I am committed to ensuring we modernize our health care delivery systems in order to root out waste and drive down costs.”

“With millions of tax dollars being handed out to prisoners and illegal immigrants, it’s pretty clear Medicare’s payment policies need to be fixed,” said Sen. Hatch. “We need to crack down on waste, fraud, and abuse in Medicare to not only protect taxpayers, but the Medicare program as well.”