??nitrd 0%tatw 0%(11811 WASHINGTON, DC 20510 August 12, 2019 The Honorable Alex Azar Seema Verma Secretary Administrator US. Department of Health Human Services Center for Medicare and Medicaid 200 Independence Avenue, S.W. Department of Health and Human Services Washington, DC. 20201 200 Independence Avenue SW Washington, DC 20201 Dear Secretary Azar and Administrator Verma: We write today to ask for more information about the Centers for Medicare and Medicaid Service?s (CMS) efforts to address fraud, waste, and abuse in light of a recent news report by ProPublica of systemic failures to stem fraud, even when properly ?agged by individuals with knowledge of the circumstances. On July 19, 2019, ProPublica reported that one such case began with an individual obtaining a fraudulent National Provider Identi?er (N PI) through CMS. The private insurance companies then neglected to review a high number of out-of-network claims from that provider number. As a result, United, Aetna, and Cigna paid $4 million for false claims to a provider that had no medical license. Moreover, failure not only to ?ag bad actors, but also to respond appropriately to repeated notices of fraudulent behavior ultimately harmed covered patients. We must work to close loopholes and gaps in our system that allow bad actors to defraud insurers and patients, especially if they are covered by health programs supported by taxpayers. Commercial health plans and their enrollees depend on the validity of federal provider identi?cation systems in order to ensure that patients? dollars are well spent. We would like to work with you to identify what additional authority CMS needs to preserve program integrity as well as what actions CMS is taking to address security gaps in light of this report. To that end, we request answers to the following questions in writing by September 9, 201 9. 1. What measures has CMS taken to strengthen the requirements for obtaining a National Provider Identi?er 2. Is CMS able to coordinate with the US. Department of Treasury to link NPI numbers and tax identi?cation numbers to ?ag fraud? 3. Does CMS regularly review NPI numbers that have unusual billing practices or claims? If so, how often do they conduct these reviews? 4. What processes does CMS have in place to respond to claims of possible NPI fraud? 5. Has CMS received similar reports of potentially fraudulent Medicare billing practices by bad actors posing as doctors providing medical services? 6. What program requirements exist to hold insurance companies participating in Medicare accountable for failure to respond to fraud? a. If such requirements don?t exist, is additional statutory authority needed for CMS to exercise suf?cient pressure to incentivize insurance companies to perform better fraud review? We look forward to hearing from you and to working together to address this matter and ensuring active role in addressing fraud in the health system. Sincerely, Catherine Co?Wastb I She%Whitehouse United States Senator United States Senator Margaret Wood Hassan United States Senator United St tes Senator I i: I . Michael F. Bennet Robert Menendez United States Senator United States Senator