An Open letter to Senator Carper and Senator Coburn in Support of the Medicare and Medicaid Fighting Fraud and Abuse to Save Taxpayers’ Dollars Act
Dear Senator Carper and Senator Coburn:
On
behalf of the 362,000-member National Taxpayers Union (NTU), I am pleased to
offer our praise and support for the many fiscal reforms contained in the
“Medicare and Medicaid Fighting Fraud and Abuse to Save Taxpayers’ Dollars
Act,” or FAST Act. This legislation would introduce vital and long-overdue pro-taxpayer
administrative and accountability measures to the federal government’s two
major health programs.
Although
laws such as the Improper Payments Elimination and Recovery Act have been
helpful in the ongoing struggle to improve the financial management of Medicare
and Medicaid, these two programs alone made a combined $70.5 billion in
erroneous payouts last year, according to testimony given in March from the
Government Accountability Office. Owing to their very structures, which involve
multiple layers of bureaucracy and vast networks of third-party payers, these
systems are among the most susceptible in the entire government to waste,
fraud, and abuse. Nonetheless, this should not serve as reason to simply accept
absurd levels of squandered tax dollars as the “price” for providing these
benefits.
The
FAST Act would take numerous steps to improve the fiduciary practices behind
Medicare and Medicaid. Among the reforms NTU strongly supports is a more formal
process for addressing vulnerabilities in payment transactions identified by
Recovery Audit Contractors (RACs). In August 2008 comments to the Senate
Committee on Finance, NTU supported what was at the time more limited pilot
programs allowing RACs to identify savings in certain parts of Medicare. These
programs, which we called “remarkably cost efficient,” have over time created
an equally remarkable archive of institutional knowledge that could help
prevent improper payments before the fact, not merely identify and recover them
after the fact. Your bill would hold the Department of Health and Human
Services more accountable for embracing this “learning curve,” which could also
potentially benefit providers by giving them more concrete claims processing
guidance in advance. The cause of “payment education” will be admirably served
through additional sections of the FAST Act requiring
expanded prepayment review of Medicare claims (and better tracking of rejected
ones), along with special review procedures for durable goods – an area that
exposes taxpayers to a high degree of risk. Another cornerstone of the FAST Act
relates to improvements in data-sharing among federal and state agencies (as
well as oversight contractors) to improve record-matching and pattern-detection
procedures. These provisions too will begin transforming the management
cultures at Medicaid and Medicare to ones more intensely committed to
preventative, as opposed to reactive, fiscal stewardship. New technologies the
FAST Act proposes, such as pilot programs using smart cards, offer further
promise of such a transformation.
Ultimately,
other fundamental reforms to Medicare and Medicaid must be undertaken to
protect taxpayers from trillions of dollars in unfunded liabilities. These
should include concepts that more actively empower beneficiaries to control
their health care spending, and strengthen the relationship between patient and
provider. Other government-wide proposals to reduce waste, fraud, and abuse,
such as legislation offering better protection for whistleblowers, could be of
great value to taxpayers as well. For too long, however, Medicare’s and
Medicaid’s bureaucracies have been slow to accept their responsibility for
absorbing cost-control techniques that at least some of the other entities
involved in these systems (such as RACs) have begun to adopt. Many provisions
of the FAST ACT can aid this evolutionary fiscal process, and NTU looks forward
to working with you and your colleagues in ushering them to passage.
Sincerely,
Pete Sepp
Executive Vice President 
Letter
