{"id":3562,"date":"2025-02-06T07:00:07","date_gmt":"2025-02-06T07:00:07","guid":{"rendered":"https:\/\/medical-article.com\/?p=3562"},"modified":"2025-02-06T07:00:07","modified_gmt":"2025-02-06T07:00:07","slug":"what-will-be-doges-impact-on-cms","status":"publish","type":"post","link":"https:\/\/medical-article.com\/?p=3562","title":{"rendered":"What will be DOGE\u2019s impact on CMS?"},"content":{"rendered":"

In a statement today<\/a>, CMS confirmed that Elon Musk and the Department of Government Efficiency (DOGE) has been given access to CMS payment systems: <\/p>\n

CMS has two senior Agency veterans \u2013 one focused on policy and one focused on operations \u2013 who are leading the collaboration with DOGE, including ensuring appropriate access to CMS systems and technology. We are taking a thoughtful approach to see where there may be opportunities for more effective and efficient use of resources in line with meeting the goals of President Trump. <\/p>\n

Why is DOGE getting access? A likely target is to identify fraud and abuse. <\/p>\n

Yeah, this is where the big money fraud is happening https:\/\/t.co\/jXqXrlKDGp<\/a><\/p>\n

\u2014 Elon Musk (@elonmusk) February 5, 2025<\/a> <\/p>\n

What is DOGE likely to find? Andy Schneider of Georgetown University<\/a> has a balanced assessment of the current state of fraud, waste and abuse for CMS programs.<\/p>\n

Waste and abuse happen in Medicaid and Medicare and private health insurance, but they are very hard to quantify\u2026
Some improper payments are lost to fraud, to waste, and to abuse.\u00a0 But most improper payments in Medicaid involve missing or insufficient documentation to support the payment that has been made.\u00a0 The Medicaid improper payment rate (5.09% in 2024) is not a fraud rate, a waste rate, or an abuse rate. <\/p>\n

Waste can take many forms in a federal-state program like Medicaid.\u00a0 One example is unnecessary emergency room visits:\u00a0 beneficiaries seeking care in a hospital ER when the health care they need could be provided in a doctor\u2019s office or a community clinic at much lower cost.\u00a0 The\u00a0reasons for unnecessary ER visits are complex<\/a>, ranging from the lack of access to\u00a0effective primary care<\/a>\u00a0to\u00a0housing instability and other social determinants<\/a>.\u00a0 <\/p>\n

Additionally, it\u2019s not as if fraud, waste and abuse have not been evaluated in the past. For instance, the Government Accountability Office (GAO<\/a>), an arm of the Congress, and the Office of the Inspector General (OIG<\/a>), an Executive Branch agency, both have responsibility for oversight of CMS and State Medicaid Agency program administration as well as for identifying waste and abuse in the program. <\/p>\n

One approach to save money would refuse any payment to providers for that could be deemed improper payments. That would save CMS money, but would shift cost to healthcare providers who either (i) wouldn\u2019t get paid if documentation was imperfect or (ii) would need to increase their spending on administrative staff to make sure all documentation was processed perfectly. <\/p>\n

In short, reducing fraud, waste and abuse in CMS is a laudable goal for DOGE to take on. Doing so in an efficient and effective manner, however, will be challenging.<\/p>","protected":false},"excerpt":{"rendered":"

In a statement today, CMS confirmed that Elon Musk and the Department of Government Efficiency (DOGE) has been given access to CMS payment systems: CMS has two senior Agency veterans \u2013 one focused on policy and one focused on operations \u2013 who are leading the collaboration with DOGE, including ensuring appropriate access to CMS systems…<\/p>\n","protected":false},"author":0,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2],"tags":[],"class_list":["post-3562","post","type-post","status-publish","format-standard","hentry","category-articles"],"_links":{"self":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/posts\/3562"}],"collection":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"replies":[{"embeddable":true,"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=3562"}],"version-history":[{"count":0,"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/posts\/3562\/revisions"}],"wp:attachment":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=3562"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=3562"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=3562"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}