CMS official scolded at hearing

The chief financial officer of the CMS' Office of Financial Management had few answers to a host of questions from lawmakers about Medicare's secondary-payer regime during a congressional oversight hearing Wednesday.

Deborah Taylor, director of that office, testified about the program she described serves as a “payer of last resort” when another insurer has the primary responsibility to pay for care of a Medicare beneficiary. An example would be if a beneficiary falls in a grocery store, the store's insurance—not Medicare—would be the primary payer.

Rep. Cliff Stearns (R-Fla.), chairman of the House Energy and Commerce Subcommittee on Oversight and Investigations, said recoveries for the Medicare secondary-payer program fall into two categories: post-payment collections for injuries that happened and were paid by Medicare, and a set-aside amount to cover future bills. But businesses and injured individuals cannot close on a settlement until the CMS provides a complete list of all medical costs, and “We have heard complaints from a variety of interested parties that CMS is not providing this information in a consistent or timely manner,” Stearns said in his opening remarks.

The Medicare, Medicaid and SCHIP Extension Act of 2007 included mandatory reporting requirements for group health plans and nongroup health plans so that the CMS could be made aware of situations in which beneficiaries had other primary payers. But those reporting requirements have not yet been fully implemented, testified James Cosgrove, the director of healthcare at the Government Accountability Office. The GAO will release a report on this topic later this year.

“We have heard concerns that the process may not be working as well as it should be,” Cosgrove said. “The nongroup health plans have raised concerns about some of the difficulties that they're facing. So one of the key objectives of the study is to examine the challenges” for the nongroup health plans and the CMS in implementing the process.

According to Taylor, the Medicare Secondary Regime program has recovered about $58 billion in the past decade. But Taylor did not have information on other issues that committee members asked about, including the number of claims for small-dollar amounts, the response times for getting information and payments to beneficiaries, the typical duration time for a settlement, and an idea of how much the CMS is failing to collect in recoveries.

“The feeling on both sides is that you just didn't seem to know much,” Stearns told Taylor, “and so we caution you: that if you come back for a second hearing, we expect you to be able to answer these questions. I assume you bring staff with you, so that these questions—you can certainly ask your staff to help you,” he added. “But to see a CFO know so little is a little disappointing.”