or federal agencies, or other assistance programs such as in-person assistors and certifiedapplication counselors. To help educate small businesses, we plan to work with regions to provide updates on recent rollouts and to conduct business outreach. We held meetings in March
in Dallas, TX and Atlanta, GA
and look forward to working with other regional offices to provide more specific information on the impact of the Affordable Care Act on businesses.
Question 2The Office of the Inspector General recently released a report describing problems with
CMS’s use of surety bond requirements. CMS currently requires durable medical
equipment (DME) suppliers to have a $50,000 surety bond for each location. CMS can thenuse these bonds to collect payment from overpaid or fraudulent providers. However, asnoted by the OIG, CMS has not effectively utilized surety bonds to collect overpayments.For example, CMS has not used authority granted to it under the Affordable Care Act toincrease the size of the surety bond for providers with a high billing volume. What are youdoing to make sure CMS is using all available tools to fight and prevent health care fraud?Answer:
I challenge my management team each and every day to improve the way we do business and I have made it clear that combatting fraud, waste and abuse in all of our programs isa top priority. We are continually looking at ways our Center for Program Integrity can leveragethe expertise of other CMS components, our contractors and law enforcement partners.CMS understands the importance of surety bonds as a program integrity tool and is exploringmultiple avenues to strengthen this important tool. Since January 2012, CMS has been workingto recover overpayment debts from Durable Medical Equipment (DME) suppliers by assertingclaims against the surety companies. As of July 2012, CMS has collected $263,000 from suretycompanies for DME supplier debts. In addition, there have been cases where DME suppliershave repaid overpayments voluntarily once they become aware CMS referred their debt to thesurety company for collection. CMS believes its efforts to collect outstanding obligations fromsurety companies will continue to spur DME suppliers to satisfy their Medicare debts.In addition to the surety bond requirement, CMS has implemented enhanced screeningrequirements for DME suppliers. All newly enrolling DME suppliers are in the highest risk category for screening and are subject to unannounced site visits and criminal backgroundchecks. These efforts will ensure that only qualified and legitimate providers and suppliers can provide health care items and services to Medicare beneficiaries. We are also leveraging other tools to more effectively combat DME fraud, waste and abuse through the use of the FraudPrevention System and DME competitive bidding.
Question 3The Affordable Care Act originally envisioned every state expanding Medicaid to cover allnon-elderly individuals with incomes up to 133 percent of poverty. But following theSupreme
Court’s ruling in July, states may choose whether to expand Medicaid. Creating
this choice for states gave CMS considerable power, because CMS must approve or denyevery Medicaid state plan. For example, in the past few months, CMS has decided thatstates must expand all the way to 133 percent of poverty to qualify for the increasedFMAP, rather than allowing states to stop at some lower coverage level, like 100 percent of poverty. Currently, CMS is deciding whether states can buy into the Exchange throughMedicaid premium assistance, as contemplated by Arkansas and Montana. All of the