North Texas News

Congressman Michael C. Burgess, M.D. (R-TX), along with other Members of Congress, has expressed deep concern over a $3 billion Medicare fraud scheme involving catheter billing. In a letter addressed to the Inspector General of the U.S. Department of Health and Human Services and the Administrator of the Centers for Medicare and Medicaid Services, the Members highlighted the severity of the issue and requested a briefing by March 20, 2024.

"We write to express our concern and request a briefing on an issue that has recently been highlighted in public reporting—a large-scale, year-long Medicare fraud scheme involving catheter billing," stated the Members in their letter. They emphasized that the failure to detect such fraud not only threatens the fiscal integrity of Medicare but also undermines the public's trust and jeopardizes the well-being of beneficiaries.

The alleged catheter billing fraud, affecting over 450,000 Medicare beneficiaries, has raised significant alarms among the Members. They pointed out that the substantial increase in catheter billing from just a few companies should have been detected and addressed promptly. There are also fears that a similar surge in fraud may have occurred with diabetes supplies, indicating a potential new threat to the Medicare program.

In addition to the concerns over the fraud scheme itself, Members criticized the lack of clear communication from CMS and HHS OIG to patients, healthcare providers, Congress, and the public. They highlighted the need for official channels of information dissemination to prevent beneficiaries from having to resort to social media platforms for crucial updates on potential Medicare fraud.

The letter was signed by various Members of Congress, including Energy and Commerce Full Committee Chair Cathy McMorris Rodgers (R-WA), Ways and Means Committee Full Committee Chair Jason Smith (R-MO), and GOP Doctors Caucus Co-Chair Greg Murphy, M.D. (R-NC).

Background information revealed that while public reporting estimated the fraud scheme to cost at least $2 billion, discussions with stakeholders suggested the actual figure could be closer to $3 billion. The Members also noted a concerning trend of increasing improper payments in Medicare since President Biden took office.

The urgency of the situation has prompted the Members to request separate briefings from CMS and HHS OIG by March 20, 2024, to gain a better understanding of the measures being taken to address the fraud and prevent its recurrence.