WASHINGTON—Senator Mike Braun, Ranking Member of the Senate Special Committee on Aging, Senator Rick Scott, and Senator J.D. Vance sent a letter to Comptroller General Dodaro of the Government Accountability Office (GAO) demanding an audit of Medicare, following reports of the $2.7 billion Medicare catheter fraud ring and the estimated $60 billion lost to Medicare fraud a year.
“The victims of Medicare fraud are often the most vulnerable Americans. I’m calling for a full audit of Medicare so we can get to the bottom of the rampant fraud, waste, and abuse. It’s beyond alarming that this recent case of alleged Medicare fraud involving overbilling for urinary catheters went undetected for over a year and accounted for an additional $2.7 billion in taxpayer spending. American seniors deserve better.” –Sen. Mike Braun
The Senators write:
“In 2022, the Government Accountability Office (GAO) estimated improper payments cost Medicare $47 billion, while other estimates put Medicare fraud at over $60 billion annually. In fiscal year 2022, only $1.7 billion was reclaimed from Medicare fraud, representing a mere 2.8 percent recovery rate. This fraud poses a substantial financial threat to older Americans, undermines our healthcare system’s integrity, and contributes to the nation’s $34 trillion deficit. In the private sector even a minor level of fraud would lead to an immediate audit of one’s finances. We request that GAO audit the Centers for Medicare and Medicaid Services’ (CMS) internal oversight reforms, such as adopting machine learning and other innovative solutions, to enhance fraud prevention and minimize the significant financial losses currently being experienced.”
The Senators continued:
“Recent investigative reports by The New York Times and The Washington Post highlighted an alleged Medicare fraud scheme uncovered by the National Association of Accountable Care Organizations (NAACOS). Using federal data, NAACOS found that over two years, 10 companies went from billing just 15 patients for catheters to an astonishing 515,000 patients, marking an increase of 50,000 from the previous year and accounting for an estimated $2.7 billion increase in taxpayer spending. This represents approximately 23.7 percent of Medicare’s total medical supply expenditures for the year, leading to the group’s conclusion that a significant portion seems to be related to fraudulent activities.
Medicare has increasingly become a target for highly sophisticated fraud schemes, including online phishing, data breaches, and international fraud rings. For instance, in 2023, there was also a significant increase in COVID-19 test kit fraud, leading to estimated losses of over $200 million dollars from the Medicare Trust Fund. These criminals exploit the communication channels between patients and providers to submit fraudulent reimbursement claims. A striking example of the ease with which these frauds are carried out was provided by a Miami individual involved in Medicare theft, who stated, ‘It’s just so easy. It’s unbelievable.’”
Read the full letter here.
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