KFF Well being Information has sued the U.S. Division of Well being and Human Providers Workplace of Inspector Normal to compel it to launch a spread of Medicare Benefit well being plan audits and different monetary data.
The swimsuit, filed Nov. 12 in U.S. District Court docket in San Francisco below the Freedom of Data Act, or FOIA, seeks paperwork from the HHS inspector common’s workplace, which acts as a watchdog over federal medical health insurance applications run by the Facilities for Medicare & Medicaid Providers.
The swimsuit asks for correspondence and different data of contact between HHS officers or their representatives and Medicare Benefit organizations regarding overpayment audit findings and potential monetary penalties.
It additionally seeks data reflecting communication between HHS and CMS officers relating to the federal government’s insurance policies for recovering overpayments found throughout Medicare Benefit audits, together with a controversial resolution in January 2023 to restrict greenback recoveries for audits courting again a decade or extra.
Moreover, the swimsuit seeks copies of presidency contracts awarded to exterior companies which have performed Medicare Benefit audits, together with budgets and efficiency evaluations, courting to 2020. In these audits, reviewers take a pattern of 200 sufferers from a well being plan and decide whether or not medical data assist the diagnoses the federal government paid well being plans to deal with.
KFF Well being Information requested the data in August, however, greater than two months later, “no paperwork, responsive or in any other case, have been produced,” the swimsuit says.
Sam Cate-Gumpert, an lawyer with Davis Wright Tremaine, which is representing KFF Well being Information professional bono within the case, stated the data is “critically essential to public oversight of presidency misspending.”
Based on the swimsuit, the inspector common’s workplace has audited the Medicare Benefit program greater than three dozen instances since 2019, revealing billions of {dollars} in overpayments.
However authorities officers haven’t recouped the overcharges, in accordance with the swimsuit.
The HHS Workplace of Inspector Normal “has left taxpayers footing the invoice for billions of {dollars} in overpayments — though HHS OIG’s main goal is to fight fraud and waste in Medicare and different federally funded well being applications,” the swimsuit alleges.
“In truth, taxpayers have been pressured to pay for the Medicare Benefit program’s wasteful spending twice — first, due to this system itself, and second, due to the prices of the audits, which the federal government spends hundreds of thousands of {dollars} to conduct,” in accordance with the swimsuit.
Medicare Benefit, principally run by personal insurance coverage corporations, has enrolled greater than 33 million seniors and other people with disabilities, greater than half of individuals on Medicare.
However this system has confronted criticism that it prices billions of {dollars} greater than it ought to with analysis exhibiting that many well being plans exaggerate how sick sufferers are to spice up funds.
A FOIA lawsuit filed by KFF Well being Information in September 2019 prompted CMS to launch summaries of 90 Medicare Benefit audits revealing hundreds of thousands of {dollars} in overpayments. As a part of a settlement, CMS paid $63,000 in KFF Well being Information’ authorized charges, although it didn’t admit to wrongfully withholding the data.
The HHS Workplace of Inspector Normal had no quick touch upon the swimsuit.
KFF Well being Information is a nationwide newsroom that produces in-depth journalism about well being points and is among the core working applications at KFF—an unbiased supply of well being coverage analysis, polling, and journalism. Study extra about KFF.
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