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Congress Pushes SGR "Doc Fix" Through House Despite Strong Opposition
[March 27, 2014]

Congress Pushes SGR "Doc Fix" Through House Despite Strong Opposition

WASHINGTON --(Business Wire)--

Today, Council for Citizens Against Government Waste (CCAGW) President Tom Schatz released a statement expressing his disappointment in the passage by voice vote of H.R. 4302, a 12-month Medicare sustainable growth rate "doc fix" that will prevent a 24 percent reduction in Medicare physician reimbursement for another year. CCAGW specifically objected to a provision in the legislation that extends the delay of both the Centers for Medicare and Medicaid Services (CMS) two-midnight rule and the suspension of recovery audit contractor (RAC) audits until March 31, 2015. The year-long delay through September 30, 2014 had already cost taxpayers as much as $4 billion.

On March 26, 2014, CCAGW and the National Taxpayers Union sent a letter to members of both the House and Senate urging them to remove the language delayingthe two-midnight rule and continuing the suspension of the RAC program. H.R. 4302 was passed quickly by voice vote on the floor of the House, a surreptitious act that denied members the opportunity to either offer amendments or oppose the entire bill. In fact, it was not clear that the bill would have passed with a recorded vote, and several members complained about the lack of transparency and abuse of the democratic process by pushing through such a controversial and important bill in such a manner.

The provisions affecting the RAC program were added to the bill despite additional evidence of the success of the program in CMS' fiscal year (FY) 2012 report to Congress, which documented how RACs recovered $2.3 billion in improper Medicare payments in FY 2012, up from $797 million in FY 2011. Furthermore, the FY 2012 report revealed that only 7 percent of RAC improper payment determinations were challenged and later overturned on appeal. Since 91 percent of improper payments in FY 2012 were from inpatient hospital claims, the continued suspension of audits on these claims will likely cost taxpayers billions of dollars. In other words, virtually at the same time proof of the efficacy of one of the most successful programs that is recovering improper payments was being provided to Congress, a provision was being added to H.R. 4302 that essentially guts the RAC program.

CCAGW President Tom Schatz said, "In addition to the unconscionable further delays to the two-midnight rule and recovery audits of short-term stay claims, the total projected to cost of H.R. 4302 is estimated to be at least $20 billion for one year, with $14 billion in increased health spending over the next two years. We are extremely disappointed that the House rushed this bill through without the opportunity for any discussion or debate. Members of Congress cannot say that they support the elimination of improper payments while they are eviscerating one of the most successful programs that has been recovering such payments. The failure to restore recovery audits for Medicare, along with short-term "fixes" of tax policy, whether they are for reductions in Medicare reimbursement for physicians or tax extenders, are some of the many reasons why taxpayers hold Congress is such low esteem."

The Council for Citizens Against Government Waste is the lobbying arm of the nation's largest nonpartisan, nonprofit organization dedicated to eliminating waste, fraud, abuse, and mismanagement in government.

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