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Letter to Health and Human Services Secretary Kathleen Sebelius: Medicare Fraud


Location: Washington, DC

Congressman Mike Fitzpatrick (PA-08) is demanding answers on improper and fraudulent payments being made by the Centers for Medicare and Medicaid Services in a letter to Health & Human Services Secretary Kathleen Sebelius.

This letter comes as a result of reports by the Department of HHS Inspector General which found that $120 million in improper or illegal payments were made between 2009 and 2011 by CMS.

A full copy of Fitzpatrick's letter is included below.

February 1, 2013

The Honorable Kathleen Sebelius, Secretary
Department of Health and Human Services
200 Independence Avenue, SW
Room 615-F
Washington, D.C. 20201

Dear Secretary Sebelius:

I write to express my tremendous concern with the latest evidence of waste, fraud and abuse in the Medicare program. I was shocked to read that, according to two reports generated from the Department of Health and Human Services (HHS) inspector general, Medicare improperly paid $120 million in services from 2009-2011 to illegal immigrants and prison inmates even though federal law prohibits their participation in the program.

According to the reports, the Centers for Medicare and Medicaid Services (CMS) are unable to stop many unlawful payments from being received by incarcerated or illegal individuals due to Medicare's outdated database. Often the database catches fraudulent claims after benefits have been received and, by the time the error has been acknowledged Medicare's system, is unable to recoup the fraudulent funds. From 2009-2011 11,600 inmates and 3,000 illegal immigrants submitted thousands of claims to Medicare resulting in received services worth millions.

In our current difficult fiscal climate, where hard working American families are struggling to make ends meet, I find it frustrating to learn that millions of dollars could be saved by diligently working to stop fraudulent claims from being received by incarcerated individuals and illegal immigrants. The Medicare program is supposed to provide health insurance to some of the most vulnerable populations in the United States; most of who paid in to the system their whole lives. Millions of seniors over the age of 65, people with disabilities, and people with permanent kidney disease in the Eighth District of Pennsylvania depend on this critically important government program. Benefits that go to illegitimate persons contribute not only to our debt but threaten the fiscal security of Medicare.

As Congress continues to make difficult decisions on reforms to protect our nation's seniors and future generations by strengthening the sustainability of programs like Medicare, it is essential that relevant agencies and Congress continue to make serious efforts to eliminate this type of blatant, unacceptable fraud. Medicare loses billions of dollars a year due to improper payments. With over $16 trillion in crushing debt, we must put an end to this expensive and illegal practice.

Therefore, I respectfully ask that the Department of Health and Human Services provide my office with answers to the following:

1) How many illegal immigrants received Medicare health benefits in Pennsylvania?
2) How many inmates received Medicare means giving benefits in Pennsylvania?
3) How much was the total monetary sum of benefits received in Pennsylvania by illegal immigrants?
4) How much was the total monetary worth of benefits received by inmates in Pennsylvania?
5) How will payments be recouped?
6) What policies and procedures will be implemented to stop abuse of the system?

I look forward to your response. Thank you for your time and attention to this matter.


Michael G. Fitzpatrick
Member of Congress

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