WASHINGTON -In a letter today, the top Republicans on the Senate Finance and Judiciary Committees, U.S. Senators Orrin Hatch (R-Utah) and Chuck Grassley (R-Iowa), asked Health and Human Services Secretary Kathleen Sebelius why the Centers for Medicare and Medicaid Services (CMS) is not utilizing some of the tools provided within the Patient Protection and Affordable Care Act (PPACA) to safeguard the Medicare program from waste, fraud and abuse.

Under PPACA, CMS can impose a temporary enrollment moratorium on new Medicare providers and suppliers when the agency determines that there is a significant potential for waste, fraud, or abuse by the applicant type or geographic area. While the final rule for this regulation was published more than eight months ago, CMS has failed to impose a single temporary moratorium. Today, the Department of Justice (DOJ) and the HHS-OIG are operating strike force initiatives in seven States (California, Florida, Illinois, Louisiana, Michigan, New York, and Texas), including Miami, Florida.  All of these areas, particularly Miami, have historically been vulnerable to Medicare fraud and are high risk areas for programmatic vulnerability. However, to date, CMS has failed to exercise its authority to protect against fraud. The National Health Care Anti-Fraud Association has estimated that as much as $60 billion is lost to fraud, waste and abuse across the Federal health care programs.

"It is deeply disconcerting that CMS has failed to act in the best interest of the American taxpayers and Medicare beneficiaries and prevent fraud before it occurs by exercising its moratoria authority," wrote the Senators.  "It is not reasonable to suggest that CMS needs more time to study whether there is need to impose a temporary moratoria in certain geographical areas for certain provider and supplier types when ample evidence exists from the strike force activities to justify moratoria in these high fraud areas."

The text of the letter to Secretary Sebelius is below and a signed copy can be found HERE:

October 25, 2011

The Honorable Kathleen Sebelius
Secretary
U.S. Department of Health and Human Services
200 Independence Avenue, SW
Washington, DC 20201

Dear Secretary Sebelius:

As the Ranking Members of the Senate Finance and Judiciary Committees, we are writing to request that as Secretary of the Department of Health and Human Services (HHS), you exercise the discretionary authority granted to you through Section 6401(a)(6) of the Patient Protection and Affordable Care Act (PPACA) regarding the imposition of temporary moratorium on the enrollment of new providers and suppliers.  Specifically, we urge you to determine why the Centers for Medicare & Medicaid Services (CMS) is failing to use this tool provided in PPACA to prevent waste, fraud and abuse.

On February 2, 2011, CMS published a final rule with comment entitled, "Medicare, Medicaid, and Children's Health insurance Programs (CHIP); Additional Screening Requirements, Application Fees, Temporary Enrollment Moratoria, Payment Suspensions and Compliance Plans for Providers and Suppliers" in the Federal Register. In part, this regulation allows CMS to impose a temporary enrollment moratorium on new Medicare providers and suppliers when CMS determines that there is a significant potential for fraud, waste or abuse with respect to a particular provider or supplier type, geographic area or both.

Today, more than year after the publication of a proposed rule and more than 8 months after publishing the aforementioned final rule with comment, CMS has still not imposed a single temporary moratorium.  In addition, despite a specific recommendation by the HHS Office of the Inspector General (HHS-OIG) to impose a temporary moratorium on independent diagnostic testing facilities in Los Angeles, California, CMS refused.

Additionally, the Department of Justice (DOJ) and the HHS-OIG are operating strike force initiatives in seven States (California, Florida, Illinois, Louisiana, Michigan, New York, and Texas), including Miami, Florida.  All of these areas, particularly Miami, have historically been vulnerable to Medicare fraud and are high risk areas for programmatic vulnerability.  Therefore, it is deeply disconcerting that CMS has failed to act in the best interest of the American taxpayers and Medicare beneficiaries and prevent fraud before it occurs by exercising its moratoria authority in some of these areas.  It is not reasonable to suggest that CMS needs more time to study whether there is need to impose a temporary moratoria in certain geographical areas for certain provider and supplier types when ample evidence exists from the strike force activities to justify moratoria in these high fraud areas.  To better understand CMS's failure to act, please:

1.      Explain why CMS decided not to impose a temporary moratorium on independent diagnostic testing facilities (IDTFs) in Los Angeles, California despite the OIG recent recommendation and previous work by the OIG that indicated $71.5 million in improper payments to IDTFs.

2.      Explain what steps CMS is taking to address the concerns raised by the OIG with respect to IDTFs in Los Angeles, California.  Please include a detailed timeline.

3.      Explain why CMS has not imposed a temporary moratorium of "high" or "moderate" categorical risk providers/suppliers in HHS-OIG strike force cities or other high-risk areas.

4.      Explain why CMS decided not to impose a temporary moratorium for durable medical equipment suppliers in south Florida when Daniel R. Levinson, the Inspector General for HHS-OIG, stated in his March 9, 2011 Congressional Testimony that there is "rampant fraud" among durable medical equipment suppliers in south Florida.

5.      Describe the program changes that CMS is considering to strengthen the provider enrollment process for "moderate" and "high" screening risk providers and suppliers, such as IDTFs, home health agencies, and suppliers of durable medical equipment, orthotics, prosthetics, and supplies.

6.      Provide all materials used to develop and finalize the temporary moratorium provisions found in CMS-6028-P and CMS-6028-IFC.

7.      Consistent with 42 CFR 424.570(a)(2)(i)(A), provide a list of providers and suppliers with a highly disproportionate number of providers and suppliers in a category relative to the number of beneficiaries for each State.

8.      Consistent with 42 CFR 424.570(a)(2)(i)(B), provide a list of providers and suppliers and location (city and state) where a rapid increase in the number of enrollment applications has occurred within the past twelve months.

9.      Consistent with 42 CFR 424.570(a)(2)(ii), provide a list of State Medicaid programs who have imposed a moratorium on a group of Medicaid providers or suppliers that are also eligible to enroll in Medicare.

10.  Consistent with 42 CFR 424.570(a)(2)(iii), provide a list of State-imposed moratoria on enrollment in particular geographic areas or on a particular providers, supplier types, or both.

We understand that we are requesting a substantial amount of information, but appreciate your understanding Congress' role in overseeing that taxpayer dollars are carefully spent. Thank you for your timely attention to this matter and we request a response by December 2, 2011.

Sincerely,

HATCH
GRASSLEY

cc: Administrator Donald Berwick, M.D., Centers for Medicare & Medicaid Services
Principal Deputy Administrator and Chief Operating Officer Marilyn Tavenner, Centers for Medicare & Medicaid Services

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WASHINGTON?Last week, the Senate Health, Education, Labor and Pensions Committee, chaired by Senator Tom Harkin (D-IA), approved a bipartisan bill to reauthorize the Elementary and Secondary Education Act by a vote of 15-7.  The legislation overhauls the No Child Left Behind Act and ensures that that every child in Iowa and across the country receives a great education that prepares them to succeed in college and a career in the global economy.  Below are comments on the legislation from education leaders in Iowa and around the country.

Chris Bern, President, Iowa State Education Association:

"I commend Senator Harkin's leadership in conducting bipartisan negotiations around this legislation that will have a significant effect on the quality of education students receive in Iowa's public schools."

Karen Rowan, President, Iowa Parent-Teacher Association

"Iowa PTA, on behalf of more than 10,000 parents, teachers, and child advocates across the state, is hopeful that comprehensive reauthorization of the Elementary and Secondary Education Act will be completed this year. We applaud Senator Harkin and Senator Enzi for their leadership to fix No Child Left Behind, and look forward to working with the Committee to make needed improvements to the bill."

Tracey Mavis, President, Iowa Head Start Association:

"Iowa Head Start Association is pleased with the results of the HELP committee Bipartisan bill to fix No Child Left Behind.  Senator Harkin has always been a Champion for Children and by his work on this bill shows that he is a driving force for all children. This bill will fix the one-size-fits-all approach created by the No Child Left Behind Act, support great teachers and principals, and ensure that all children receive the best instruction, help ensure that every student graduates from high school ready for college and a career, focus the federal government's role on the things it does best, while giving states and communities the flexibility they need to address the unique needs of their students and schools.  These changes will help strengthen child education and help move this country forward."

MJ Dolan, Executive Director, Iowa Association of Community College Trustees:

"Iowa's Community Colleges support the bipartisan focus of this bill on establishing career and college readiness standards with high quality assessments for students.   We believe this legislation will assist in developing a K-12 educational system where every student has the opportunity to succeed.  Moving forward with a comprehensive reform package will enable the U.S. to remain globally competitive with our international counterparts.  IACCT looks forward to continuing its partnerships with the elementary and secondary education community to end remediation and support students in their pursuit of postsecondary education through innovative and effective partnerships. We hope that Congress moves forward quickly with this legislation."

Mark Shriver, Save the Children:

"On behalf of Save the Children's U.S. Programs, I am proud to endorse the Harkin/Enzi Reauthorization of the Elementary and Secondary Education Act.  This bipartisan legislation provides important reforms for education policy, including a long overdue recognition of the needs of children in rural America.  I urge the Senate to move forward as soon as possible and work with their colleagues in the House to produce a final bipartisan bill."

Deborah Smolover, Executive Director, America Forward:

"The America Forward Education Coalition is pleased with the Senate HELP Committee's decision to vote a bipartisan education bill out of committee.  This bill is a critical first step in moving education reform forward.  We are grateful to Chairman Harkin, Ranking Member Enzi and HELP Committee Senators who voted in favor of passage for their leadership in the effort to ensure all of our nation's children receive a quality education.  As nonprofit organizations who work as partners to schools in communities throughout the country to improve educational outcomes for our nation's students, we support provisions throughout the bill that incentivize partnerships with effective nonprofit organizations.  We also support competitive funding streams that have been included like Race to the Top, Investing in Innovation and Promise Neighborhoods.  We will continue to work to ensure these vital provisions remain in the bill as it is considered on the Senate floor.  We applaud the Senate HELP Committee's action to move this bipartisan bill, demonstrating what is possible when we put politics aside and focus on the urgent needs of our country's students."

Gov. Bob Wise, President, Alliance for Excellent Education:

"The Senate's action today is particularly important for the nation's high schools. Over 40 percent of the nation's dropouts come from 12 percent of high schools, and, under NCLB, federal education policy did very little to turn around these schools... The bill will help to ensure that the high school diplomas students receive are meaningful?and businesses, parents and the community will know that the diploma is meaningful. Building on the work of states across the country, the legislation calls for college and career-ready standards. By raising standards and holding students to high expectations, the nation will help prepare its students for the competitive future that lies ahead."

Jason Grumet, President, Bipartisan Policy Center:

"Yesterday, the Senate Health, Education, Labor, and Pensions Committee reached a bipartisan agreement to advance legislation that would overhaul the No Child Left Behind Program. We at BPC commend Chairman Tom Harkin, Ranking Member Michael Enzi and their fellow committee members on their willingness to overcome partisan differences in the service of a greater good, and to demonstrate that consensus between the two parties is still possible... It is imperative that Republicans and Democrats continue to show the type of leadership displayed by the members of the HELP committee. Breaking through the wall of partisanship on difficult issues is vital to ensuring the future health of our country and to addressing the cynicism and discontent with Congress so evident in poll after poll."

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Nearly 20 Soldiers Return Oct. 28 After Deploying As an Embedded Training Team

BLOOMINGTON, IL (10/25/2011)(readMedia)-- A homecoming ceremony is scheduled for approximately 20 Illinois Army National Guard Soldiers with Bilateral Embedded Staff Team (BEST) A7. The ceremony for BEST A7 will be Oct. 28 at 11 a.m. at the Bloomington National Guard Armory, 1616 S. Main St. in Bloomington.

The team was mobilized in January. It deployed to Poland for approximately two months to train with the Polish Land Forces before departing for Afghanistan. The unique mission allows Illinois Army National Guard Soldiers to train and deploy side-by-side with their Polish counterparts. The Soldiers are from various parts of Illinois and were selected for the mission based on their training and skills.

The team provided operational, intelligence, logistical, communications, engineering and planning support to the ninth rotation of Polish Forces to Afghanistan. The task force it supported was composed of almost 4,000 Polish and U.S. forces assisting more than 9,000 Afghan security forces in one of the largest provinces in eastern Afghanistan.

The team completed several ongoing construction projects designed to improve the safety and expand the reach of all security forces in the Ghazni Province.

The Soldiers also established development and transition programs for several of the less violent districts.

Most of the team participated in convoy and combat operations supporting Polish and Afghan Forces.

News media attending the event should arrive at least 30 minutes prior to the ceremony. For more information call the Public Affairs Office at 217-761-3569.

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Protest at Iowa Social Security Offices

Social Security Advocates Join Forces to Protest Budget Cuts, Proposed Cuts will Severely Impact Service to Public

WHAT: An informational picket at Social Security offices around the country

WHEN: 12:00 pm, Thursday, October 27, 2011

WHERE:              

• Council Bluffs Social Security Office, 20 Arena Way
• Des Moines Social Security Field Operations, 455 SW 5th Street
• Dubuque Social Security Office, 1635 Associates Drive
• Waterloo Social Security Office, 3121 Greyhound Drive

WHO: American Federation of Government Employees Social Security employees

Alliance for Retired Americans

National Committee to Preserve Social Security and Medicare

Strengthen Social Security Campaign

Thousands of American Federation of Government Employees Social Security employees, along with the Alliance for Retired Americans, the National Committee to Preserve Social Security and Medicare, and the Strengthen Social Security Campaign across the country are taking to the streets on October 27 at 12:00 p.m. to protest recent proposals from Congress that would cut the Social Security Administration's operational budget.

"Cutting Social Security's budget at a time that record baby boomers are seeking benefits is another example of bad Washington politics.  These cuts will only punish Americans who count on Social Security and Medicare by adding to backlogs and limiting assistance for our seniors, the disabled and families that have lost a parent or spouse," explained Witold Skwierczynski, president of AFGE's Council of Field Operations Locals.

Congress has proposed reductions from $ 473 to 882 million from President Obama's budget request in SSA funding for 2012. FY 2011 current status, results from nearly $1 billion below the amount the President requested.

As a result of those cuts, SSA implemented an agency-wide hiring freeze with the exception of the hearings operations.  This resulted in a loss of more than 3500 SSA and DDS (Disability Determination Service) State employees.  More than 300 contact stations were closed, eliminating in-person services in many rural and remote sites.   SSA indefinitely suspended mailing the Social Security statement, without advance notice to the public, eliminating an important link between young workers and the benefits they will receive when they retire.