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Politicians getting involved in Medicare fraud investigations

Political intervention helped Texas, Florida facilities keep payments

Even Medicare fraud investigations are not immune to political pressure, according to an investigative article from the Wall Street Journal. The newspaper details instances in which governors and state representatives have interjected themselves into fraud investigations, blocked payments and prepayment reviews.

For example, in 2012, the Centers for Medicare & Medicaid Services moved to block payments to Houston's Riverside General Hospital after the provider filed Medicare claims for patients that weren't treated. Rep. Sheila Jackson Lee (D-Texas) intervened by contacting CMS Administrator Marilyn Tavenner, arguing the blocked payments would put the hospital at financial risk, according to the WSJ. Weeks later, an order came down to restore payments to the hospital.

In another instance, in 2011, CMS contractor SafeGuard Services LLC investigated 33 skilled-nursing facilities (SNFs) in Florida for overcharging physical and occupational health services. When the agency later blocked payments to the SNFs, Gov. Rick Scott (R-Florida) connected the Florida Health Association directly with Tavenner. Later that year, Tavenner ordered officials to release payments.

The article also points out the political contributions that lobbyists make to lawmakers that oversee Medicare spending. This year, for example, hospitals and nursing homes gave Rep. Kevin Brady (R-Texas), chairman of the House Ways and Means health subcommittee, $218,000 in campaign donations. In addition to campaign contributions, politicians have some skin in the game, since health providers are often significant job suppliers in the community.

Both Texas and Florida have come under recent fire for Medicaid overpayment. Texas must ramp up its Medicaid fraud efforts, according to auditors who found more than $1 billion in overpayments in 2012 and 2013. Meanwhile, FierceHealthFinance previously reported that the federal government says Florida owes $267 million in Medicaid overpayments that occurred over an eight-year period.

For more:
- read the Wall Street Journal article

Related Articles:
Auditors: Texas must ramp up Medicaid anti-fraud efforts
A Texas-sized fraud settlement mess
Feds want $267M in Medicaid overpayments back from Florida's hospitals