As previously reported weeks ago, hearings were being conducted in Washington D.C. which are of interest to all involved with Medicare repayment and MSA issues. A hearing was conducted by the Subcommittee on Oversight and Investigations, Committee on Energy and Commerce on Wednesday June 22, 2011 at the Rayburn Building in Washington D.C., to discuss H.R. 1063, the Strengthening Medicare and Repaying Taxpayers Act.
Barbara Taylor, Chief Financial Officer and Director, Office of Financial Management for Center for Medicare and Medicaid Services (CMS) testified as well as James C. Cosgrove, Director, Health Care, United States Government Accountability Office. Ms. Taylor and Mr. Cosgrove entered written statements and were then questioned by the Subcommittee members. Ms. Taylor testified that Medicare is responsible for approximately 413,000 Secondary Payer claims and acknowledged that the implementation of Mandatory Insurer Reporting has doubled the CMS workload over the last eighteen months. She estimated CMS has recovered $600,000,000.00 as a result of the CMS conditional payment recovery efforts, however she wasn’t able to respond appropriately to many questions regarding delays in response as well as thresholds of the conditional payment claims sought to be recovered, the average response time of the Medicare Secondary Payer Recovery Contractor MSPRC or the rejection rate of data electronically transferred to Medicare which may trigger recovery efforts. She acknowledged "problems" including the fact that the MSPRC is overwhelmed with their workload. Mr. Cosgrove essentially advised the Subcommittee that he was unable to objectively measure the performance of CMS and was unable to testify about the efficiency of the process. He noted five elements within the system: notification, negotiation, resolution, reporting and recovery. However, it was also noted that they have been unable to gather data to quantify the process and its effect on beneficiaries or the Medicare Trust Fund.
All reports confirm the Subcommittee, particularly Chairman Cliff Stearns (R-FL), seemed quite unsatisfied with the CMS presentation and the lack of concrete data or knowledge of MSPRC performance, the amount of potential recovery dollars, and the reasons for the 120-150 day lag in requests for conditional payment information and its receipt. Other witnesses, including Marc Salm, Vice President of Risk Management for Publix Supermarkets; Scott Gilliam, Vice President and Government Relations Officer for Cincinnati Insurance Companies; Jason Matzus, a Personal Injury Attorney at Raizman, Frischman & Matzus and Ilene Stein, Federal Policy Director for the Medicare Rights Center testified generally to procedural roadblocks and lack of standard thresholds or guidelines as well as CMS and MSPRC lack of responsiveness and its effect.