MEDIA CONTACTS: Kevin Smith (Portman) | 202-224-5190
John LaBombard (McCaskill) | 202-228-6263
Washington, D.C. – Today, U.S. Senators Rob Portman (R-OH) and Claire McCaskill (D-MO), Chairman and Ranking Member of the Permanent Subcommittee on Investigations (PSI), released a bipartisan report examining the significant role that the Centers for Medicare and Medicaid Services (CMS) and private health insurers play in detecting, reporting, and addressing opioid abuse. Specifically, the Subcommittee examined the efforts undertaken by CMS and its main program integrity contractor, the Medicare Drug Integrity Contractor (MEDIC), to address opioid-related fraud and abuse in Medicare Part D. In addition, the Subcommittee examined the anti-opioid abuse efforts of six of the nation’s largest health insurance companies—both in their commercial insurance business and in their role as Medicare Part D plan sponsors.
The Subcommittee’s investigation concluded that CMS’s efforts suffer from a lack of clear standards governing when health insurance companies should report cases of waste, fraud, and abuse, including abuse of opioids. As a result, insurer report abuse cases at widely different rates. In addition, CMS’s main program integrity contractor investigated only seven percent of all actionable waste, fraud, and abuse complaints from private health insurers in 2015. The contractor’s total number of investigations—generated both by private health insurer’s complaints and by other leads—has been steadily declining since 2008. The investigation also found that a multimillion-dollar CMS database created to track opioid abuse schemes across insurers remains relatively unused by private health insurers.
Finally, the Subcommittee examined the efforts of private health insurers and found that the use of important tools to combat opioid abuse vary widely between insurers—suggesting the tools may be underutilized.
“The abuse of opioid drugs is a national health crisis. The Subcommittee’s investigation found that the federal government can, and must, do more to combat opioid fraud and abuse,” Senators Portman and McCaskill said. “Private health insurance companies on the front lines of this crisis also must boost their efforts to use every available tool and piece of data to identify and care for beneficiaries in need of help.”