Senate Subcommittee Presses CMS on Audits, Payments

The Senate Homeland Security and Governmental Affairs Committee’s Subcommittee on Financial and Contracting Oversight held a hearing on Wednesday entitled “Oversight and Business Practices of Durable Medical Equipment Companies.” Senator Claire McCaskill (D-Mo.), the Chair of the subcommittee, called the hearing following complaints she received from constituents in Missouri about marketing practices of home medical equipment companies. While aggressive marketing was the focus of the hearing and not all of the questioning and testimony was positive, much of the hearing focused on audits and other payment integrity efforts.

OPGA and our parent company, The VGM Group, were offered the opportunity to submit information in the form of our VGM Audit White Paper Submission and potential questions for CMS at the subcommittee hearing. Senator McCaskill and ranking member Senator Ron Johnson (R-WI) aggressively questioned CMS Director of Program Integrity Dr Peter Budetti on the effectiveness of their audit programs and their lack of being able to recover supposed identified overpayments. They were also unable to answer the question of what percent of the identified overpayments are due to fraudulent practices or are simply clerical errors on proper claims. When pushed on how many identified overpayments are actually fraudulent, Budetti stated “our programs…are not appropriate for measuring fraud”.

Senator Johnson also questioned why claims appealed to the Administrative Law Judge level are being overturned at such an alarming rate. Senator Tammy Baldwin (D-WI) detailed a story from a Wisconsin prosthetist about delayed payments for over a year and the pressure it is putting on their business and patient care. Please take the time to watch a portion of the hearing. We will continue to follow-up with subcommittee staff and will report any updates as they become available.

Senator Baldwin, Johnson and McCaskill’s key sections on CMS audit programs begin at the 1:23 and conclude at 1:50. The video can be found here. 

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