Study shows failures in Medicare management
GAO found "pervasive deficiencies" in contract management by metro-Baltimore's own Centers for Medicare and Medicaid Services, which run the giant federal health programs. The Government Accountability Office concluded: "The continuing weaknesses in contracting activities and limited progress in addressing known deficiencies will continue to put billions of taxpayer dollars at risk of improper payments or waste."
Note that the problems have to do with contractors Medicare/Medicaid hires to do its job -- administering and auditing claims, keeping computers working, consulting and running the 1-800-MEDICARE phone line. It's work outsourced to the private sector -- not money to pay for medical services. Nevertheless, as someone who supports expanding the Medicare/Medicaid administration's power to run a public health option for all Americans, I admit that the GAO report does not inspire confidence in the organization's competence. GAO said:
These control deficiencies... stem from a weak overall control environment as characterized primarily by inadequate strategic planning for staffing and funding resources. CMS also did not accurately capture data on the nature and extent of its contracting, which hinders CMS’s ability to manage its acquisition function by identifying areas of risk, due to a lack of quality assurance procedures over data entry. CMS also has not substantially addressed seven of the nine recommendations made by GAO in 2007 to improve internal control over contracting and payments to contractors.
For example, CMS has not made progress in clarifying the roles and responsibilities for implementing certain contractor oversight responsibilities and, as of July 2009, CMS still had a backlog of contacts that were overdue for closeout, putting CMS at increased risk of not identifying or recovering improper payments or waste.Pervasive deficiencies in CMS contract management internal control increase the risk of improper payments or waste. Specifically, based on our statistical random sample of 2008 CMS contract actions, GAO estimates that at least 84.3 percent of fiscal year 2008 contract actions contained at least one instance where a key control was not adequately implemented. GAO also estimates that at least 37.2 percent of fiscal year 2008 contract actions had three or more instances in which a key control was not adequately implemented.
Comments
I think you have only touched the tip of the problem. Last year I was trying to submit claims to CMS on medical supplies that I purchased. The contractors that CMS hires in each region to process claims either rejected my claims or told me to send to a different region. I would go onto their website to confirm the correct address to submit my claim, and it gave the same location that I was mailing it to. This went on for months. I needed them to
send me a letter to pay for or deny the claim so I can submit it to my other insurance. I never got either what I did get was someone else's claim forms attached to mine with all of their personal history and claim problems. I sent a letter to both CMS on this issue and have never hear a response back. I contacted the people who I received their personal information from and told them the problem and returned their information. I asked them to file a complaint and they did and was told that there was no proof. I'm sure that more people than us our experiencing these problems. Guess what I have never gotten a denial for serives or been reimbursed for my out- of -pocket expenses for medical supplies.
Posted by: Dana Govef | November 25, 2009 10:41 AM
I can certainly believe that Medicare is not adequately trained. Several years ago I worked for an attorney whose wife was injured in an auto accident in D.C. At some point, she received a settlement of $25,000 insurance money. This was supposed to be returned to Medicare to help offset her medical costs paid by Medicare. The attorney placed this money in a special savings acccount and called Medicare re where to sent the money. He then copied a 2 inch thick stack of medical records as requested and sent it to the Medicare office. It took many phone calls, three more copies of this stack of medical papers and TWO years before the people at Medicare finally figured out which office was responsible for this and the attorney was able to send the money to Medicare. About 7 years later his wife was injured in another accident in D.C. I thought that Medicare might have their act together by then. However, the office was not the same as before and another 2 years expired before the attorney was able to find the right office to send the insurance settlement to Medicare.
I dare say that there are few people who receive insurance settlements that would bother to continue to try to return Medicare's share in the face of such incompetence! One would think that the office responsible for receiving money would be better organized and known within the Medicare administration.
Heaven help us if a health care option is passed!!
Posted by: Jeanette | November 27, 2009 9:48 AM