Policy & Regulation News

CAGW criticizes CMS, Marilyn Tavenner for ACA expenditures

By Elizabeth Snell

- Last week, Citizens Against Government Waste (CAGW) stated that the Centers for Medicare & Medicaid Services (CMS) had a “dismal record on financial accountability” and also knocked the organization for dismantling “one of the federal government’s most effective improper payment recovery programs.”

Because of this, CAGW awarded CMS administrator Marilyn Tavenner with its September Porker of the Month award. Tavenner was given the award because she did not establish reliable accounting procedures, CAGW explained in a statement. Moreover, Tavenner allowed CMS to undercut the success of the current recovery audit contractors (RAC) program, and by extension, the solvency of the Medicare Trust Fund, the agency said.

CAGW cited a September 2014 report by the Government Accountability Office (GAO) that showed CMS could not account for $3.7 billion in expenditures associated with the implementation of the Affordable Care Act (ACA).

“While CMS had policies and procedures for its standard financial operations, it did not have documented policies and procedures for responding to non-routine information requests,” explained the GAO report. “Instead, CMS relied on ad hoc manual procedures that were labor intensive and time consuming.”

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  • The report added that CMS does not have documented procedures to ensure that data requests are reviewed and approved for accuracy.

    CAGW previously sent a letter to members of the Senate Special Committee on Aging to clarify some common misconceptions about Medicare’s RAC program. According to CAGW, it reiterated the important role RACs play in identifying areas vulnerable to improper payments. Specifically, CMS released figures on September 1, 2014 that showed that RACs have returned more than $8.9 billion to the Medicare Trust Fund and more than $700 million to providers since 2009.

    “The GAO report underscores the imperative for CMS bureaucrats to work harder to prevent the hemorrhaging of taxpayer dollars,” CAGW President Tom Schatz said in a statement. “That means developing and maintaining a rational recordkeeping system to track detailed financial information, as well as broadening the scope of the RAC program, one of the most successful tools to protect taxpayers and Medicare beneficiaries from rampant improper payments.”

    This is not the only criticism CMS has received this month. The Department of Health & Human Services (HHS) said in a September 11, 2014 report that CMS has not issued final regulations to a portion of Rural Health Clinics (RHCs) that would enable those facilities to be considered an essential healthcare provider.

    HHS recommended in its report that CMS issue regulations to ensure that RHCs determined to be essential providers remain certified as RHCs. That way, only RHCs determined to be essential providers continue to receive enhanced reimbursements.