Grassley Asks for Information About Incomplete Federal Inquiries Into Abuse of Medicaid Program
Grassley Asks for Information About Incomplete Federal Inquiries Into Abuse of Medicaid Program
Sen. Chuck Grassley has asked the Attorney General and the Secretary of Health and Human Services for information about why inquiries by their departments into inappropriate Medicaid claims for school-based services were stopped in 2002, as reported this summer by the New York Times.
Grassley is Chairman of the Senate Committee on Finance, which is responsible for Medicaid legislation and oversight. In June he conducted two days of hearings about Medicaid fraud, waste and abuse. The budget resolution adopted by Congress this year directs the Finance Committee to reduce expenditures on Medicaid and other programs by $10 billion over the next five years.
The text of Grassley's letters to Attorney General Alberto Gonzales and Secretary Michael Leavitt follows here.
August 23, 2005
The Honorable Alberto Gonzales
Attorney General
United States Department of Justice
950 Pennsylvania Avenue, N.W.
Washington, DC 20535
Dear Attorney General Gonzales:
The U.S. Senate Committee on Finance (Committee) has jurisdiction over the Medicare and Medicaid programs, and, accordingly, a responsibility to the more than 80 million Americans who receive health care coverage under these programs. As Chairman of the Committee, and as a senior member of the United States Senate, it is my Constitutional duty to ensure that Federal monies, including Medicare trust funds, are spent in an appropriate manner, free of fraud, waste, or abuse.
Recently, the Committee held two days of hearings focused on fraud, waste and abuse in the Medicaid program. During the hearings, the Committee heard testimony from the Office of Inspector General (OIG), Department of Health and Human Services and the Government Accountability Office (GAO) regarding state projects to maximize Federal Medicaid reimbursements. According to both the OIG and the GAO, these projects are questionable and may threaten the long-term integrity and stability of the Medicaid program.
In particular, both the OIG and the GAO testified regarding school-based services associated with state projects. Under the Individuals with Disabilities Education Act, schools are allowed to claim reimbursement from Medicaid for services provided to students. School-based services, ranging from speech therapy to transportation service, are intended to help students, however, three audits conducted by the OIG paint a different picture. The OIG reports found that nearly $620 million in Federal matching funds were inappropriately spent by the State of New York and New York City on school-based services between 1993 and 2001.
These losses represent a significant portion of Federal Medicaid dollars that were intended to provide meaningful and potentially life-saving care to the Nation's most vulnerable populations.
It has come to my attention that the Civil Division of the Department of Justice (Department) began an inquiry into this matter back in April of 2002. Specifically, this inquiry requested information from both the State of New York and New York City regarding Federal reimbursement for school based Medicaid services dating back to 1993. While this review requested information, it is unclear whether the Department received any documents in response to its request. Further, I question why the Department decided to suspend its inquiry into this matter in July of 2002, as reported in a recent article in The New York Times. These unanswered questions raise concerns that enforcement of Medicaid fraud, waste, and abuse by Department
may not be as high a priority as it should be.
Accordingly, I request that you provide a detailed briefing to address the following questions:
(1) Did the Department suspend its civil inquiry into questionable spending in the state of New York and New York City back in 2002?
(2) If so, what is the current status of any Department inquiry into school-based service reimbursement by Medicaid in both the state of New York and New York City?
(3) If the Department's inquiry is closed, what was the basis for closing it?
(4) How many open investigations into school based Medicaid reimbursement in any jurisdiction remain open at this time? In responding, provide the jurisdiction in question, the estimated loss to Medicaid, and a current status of the inquiry.
Thank you in advance for your attention to this matter.
Sincerely,
Charles E. Grassley
Chairman
August 23, 2005
The Honorable Michael O. Leavitt
Secretary
Department of Health and Human Services
200 Independence Avenue, S.W.
Washington, D.C. 20201
Dear Secretary Leavitt:
The U.S. Senate Committee on Finance (Committee) has jurisdiction over the Medicare and Medicaid programs, and, accordingly, a responsibility to the more than 80 million Americans who receive health care coverage under these programs. As Chairman of the Committee, and as a senior member of the United States Senate, it is my Constitutional duty to ensure that Federal monies, including Medicare trust funds, are spent in an appropriate manner, free of fraud, waste, or abuse
.
Recently, the Committee held two days of hearings focused on fraud, waste and abuse in the Medicaid program. During the hearings, the Committee heard testimony from the Office of Inspector General (OIG), Department of Health and Human Services and the Government Accountability Office (GAO) regarding state projects to maximize Federal Medicaid reimbursements. According to both the OIG and the GAO, these projects are questionable and may threaten the long-term integrity and stability of the Medicaid program.
In particular, both the OIG and the GAO testified regarding school-based services associated with state projects. Under the Individuals with Disabilities Education Act, schools are allowed to claim reimbursement from Medicaid for services provided to students. School-based services, ranging from speech therapy to transportation service, are intended to help students, however, three audits conducted by the OIG paint a different picture. The OIG reports found that nearly $620 million in Federal matching funds were inappropriately spent by the State of New York and New York City on school-based services between 1993 and 2001.
These losses represent a significant portion of Federal Medicaid dollars that were intended to provide meaningful and potentially life-saving care to the Nation's most vulnerable populations. It has come to my attention that the DOJ began an inquiry into this matter back in January of 2002. Specifically, this inquiry requested information from both the State of New York and New York City regarding Federal reimbursement for school based Medicaid services dating back to 1993. For reasons which remain unknown, this investigation by DOJ was suspended back in 2002, according to reports that appeared in The New York Times last month. In this same article, the author stated that an investigation on the part of the Department of Health and Human Services (Department) was also put on hold for a reason that has not been made public.
Accordingly, I request that you provide a briefing to address the following concerns:
(1) Did the Department agree to forgo the collection of any restitution from school districts that were found to have utilized school based services to increase their Federal share of Medicaid funds?
(2) If so, what is the current status of any Department inquiry into school-based service reimbursement by Medicaid in both the state of New York and New York City?
(3) Has the Department initiated a review of school based services to determine if other states have used these services as a means to facilitate a higher share of Federal Medicaid dollars?
(4) Does the Department plan on revising the regulatory guidance for states to follow regarding school based Medicaid services?
Thank you in advance for your attention to this matter.
Sincerely,
Charles E. Grassley
Chairman
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http://finance.senate.gov/press/Gpress/2005/prg082305.pdf