| | | | |  | | By Ben Leonard and Chelsea Cirruzzo | | | With Kelly Hooper
| | |  The GAO says the Office of Personnel Management has never audited the eligibility of the workers on the Federal Employees Health Benefits Program. | POLITICO illustration/Photos by iStock | A BILLION-DOLLAR SCAM — Fraudulent enrollees in the Federal Employees Health Benefits Program could be costing billions of dollars a year in taxpayer money, Kelly reports. The Office of Personnel Management, which oversees health insurance for 8 million federal workers and their families, has never conducted an audit for eligibility on its rolls, according to a report from the Government Accountability Office, which has been pushing OPM for years to improve its oversight. OPM’s Office of Inspector General has estimated the cost of ineligible enrollees in the program to be between $250 million and $3 billion a year. That’s unacceptable, said Sen. Rick Scott (R-Fla.), who plans to introduce a bill in March to require OPM to audit its members. “OPM does not care about fraud, or they would do it. It’s not that hard,” said Scott, who requested the GAO report. “Companies do it all the time, and states do it all the time. It's real simple to put a program in place to do it, so if you don’t do it, that means you support fraud.” A spokesperson for OPM balked at claims that fraud is not a high priority, telling POLITICO the agency “takes the integrity of the FEHB Program very seriously and is working diligently with agencies to address improper enrollments within the constraints of our resources from Congress.” Despite prodding from the GAO, the agency has no plans to conduct an audit, saying it would be too costly. OPM relies on more than 160 government employment offices and more than 70 contracts with health insurance carriers to enroll and verify the eligibility of FEHB members. That means the $120 million audit would come out of its budget while the savings accrue to enrolling agencies, according to OPM. The agency is instead focused on a “fully funded, centralized enrollment system for FEHB that would address the issues underlying improper enrollments” instead of conducting a backward-looking audit. OPM declined to comment on whether it’s pursuing funding for a centralized enrollment system or on the status of implementing the system. Dozens of states have conducted comprehensive audits on their health benefits plans, including Florida when Scott was governor in 2018. That audit found roughly 3 percent of enrollees were ineligible, resulting in more than $20 million a year in savings to the state. New Jersey also saved taxpayers tens of millions of dollars after its 2019 audit led to more than 13,000 ineligible dependents being removed from the state health plan. WELCOME TO WEDNESDAY PULSE. We hope you have a better day than everyone who bought tickets to the Willy Wonka Experience in Glasgow. Reach us at bleonard@politico.com or ccirruzzo@politico.com. Follow along @_BenLeonard_ and @ChelseaCirruzzo.
| | | | A message from Coalition for Medicare Choices: There are 33 million reasons to protect Medicare Advantage. That’s how many Americans count on the program for more affordable health care with additional benefits and better health outcomes. In fact, Medicare Advantage saves seniors an average of $2,400 annually compared to fee-for-service Medicare – savings that are particularly important because Medicare Advantage serves a population that is disproportionately low-income. Protect Medicare Advantage. | | | | | | | 
Sen. Susan Collins says funding negotiations are "in better shape than people realize." | Francis Chung/POLITICO | PROGRESS ON FUNDING — Facing a Friday deadline, Congressional leaders said Tuesday they’re getting closer to resolving four bills, including those funding the FDA and the VA, POLITICO’s Caitlin Emma and Daniella Diaz report. Sen. Susan Collins (R-Maine), the GOP's top appropriator in the Senate, said discussions are “in better shape than people realize.” Negotiations on the other bills, including the one funding HHS with a March 8 deadline, aren’t going as well, she said. Congressional leaders are eyeing another spending patch further into March. Also on the Hill: Senate Finance Chair Ron Wyden (D-Ore.) expressed frustration with the House on Tuesday as negotiations over pharmacy benefit manager reform hit an impasse, saying he’s not sure where the lower chamber might be open to negotiation. “I’m baffled by it … I haven’t seen anything like it,” Wyden told Pulse. “Usually people want something different, and then you can come together, but [it’s] just a wall of resistance.” Sen. Bill Cassidy (R-La.), ranking member of the Senate Health, Education, Pensions and Labor Committee, said negotiations are ongoing, and he’s “open for business.” Senate HELP Chair Bernie Sanders (I-Vt.) said, “We’ll see what happens,” adding that a deal is “obviously” something he’d like to see. Some lobbyists have blamed Cassidy for insisting on the HELP Committee's proposed reforms. IVF STATE OF PLAY — In the wake of Alabama’s Supreme Court ruling deeming frozen embryos as children, Senate Republicans say they plan to block a Democratic bid Wednesday to add protections for in vitro fertilization in federal law, saying it’s a states-rights issue, Daniella and POLITICO’s Ursula Perano report. Sen. Tammy Duckworth (D-Ill.) has said she’ll seek unanimous consent to pass her bill to protect IVF, but that’s a move any one senator can stop. “It’s idiotic for us to take the bait,” said Sen. J.D. Vance (R-Ohio), who said he was referring not to Duckworth’s bill but to Democrats’ attempts to use the proposal as an IVF messaging tool. Meanwhile, in the House: Rep. Nancy Mace (R-S.C.) is pitching a nonbinding resolution offering “strong support” for IVF, POLITICO’s Alice Miranda Ollstein reports. Mace’s office said Tuesday she wasn’t aware of Duckworth’s bill. A Mace aide said in a statement to POLITICO that the resolution “is not in lieu of introducing a bill, but a first step in building a bipartisan coalition to ensure couples struggling with infertility throughout this country have access to IVF, and other [assisted reproductive technologies].” In Alabama: The state’s GOP-controlled legislature is working on a compromise to restore access to IVF after the state Supreme Court decision, POLITICO’s Megan Messerly reports. Republican lawmakers propose giving civil and criminal immunity to doctors providing IVF. Unlike a previous draft, the legislation doesn’t say that embryos created via the IVF process are “potential life” but not “human life.”
| | | | CONGRESS OVERDRIVE: Since day one, POLITICO has been laser-focused on Capitol Hill, serving up the juiciest Congress coverage. Now, we’re upping our game to ensure you’re up to speed and in the know on every tasty morsel and newsy nugget from inside the Capitol Dome, around the clock. Wake up, read Playbook AM, get up to speed at midday with our Playbook PM halftime report, and fuel your nightly conversations with Inside Congress in the evening. Plus, never miss a beat with buzzy, real-time updates throughout the day via our Inside Congress Live feature. Learn more and subscribe here. | | | | | | | | | NEW STRATEGIC CYBER PLAN — The HHS-designated group tasked with coordinating cybersecurity efforts unveiled on Tuesday its latest strategic plan to deal with growing cybersecurity threats in the health care sector. The five-year plan developed by the Health Sector Coordinating Council Cybersecurity Working Group, crafted in partnership with HHS, the DHS and other federal agencies, outlines several goals. They include “feasible” and “harmonized” cybersecurity requirements in the sector, plus “911 cyber civil defense” capabilities to ensure early warnings. “The fast pace of new technology adoption is creating a growing gap between slowly developing security posture and rapidly evolving security threats,” the group wrote. Zooming out: The plan comes as the industry is under siege from cyberattacks, including a recent attack on UnitedHealth’s Change Healthcare, which has disrupted filling prescriptions and processing claims. Ransomware attacks have the potential to disrupt care and threaten patients’ lives.
| | | | A message from Coalition for Medicare Choices:   | | | | | CONTROVERSIAL RULE DUE THIS WEEK — An EPA regulation that aims to curb industrial releases of a carcinogenic gas is set to be released by Friday, per the terms of a court settlement. The regulation, under White House review, would limit emissions of ethylene oxide from facilities that use it to sterilize medical devices. But the medical device industry and the FDA have warned that the rule could impact supply chains for crucial medical products. White House staffers have met with environmental advocates and medical device suppliers in recent weeks to discuss the rule’s potential impact, POLITICO’s Annie Snider and David Lim report. Medical device industry representatives have also met with the Defense Department and NIH to raise concerns about potential supply-chain issues. An EPA spokesperson said the agency is “working to finalize a rule that will address pollution concerns associated with [ethylene oxide], ensuring facilities can meet emissions requirements while also ensuring supply chains for sterilized medical supplies are not disrupted.”
| | | | YOUR TICKET INSIDE THE GOLDEN STATE POLITICAL ARENA: California Playbook delivers the latest intel, buzzy scoops and exclusive coverage from Sacramento and Los Angeles to Silicon Valley and across the state. Don't miss out on the daily must-read for political aficionados and professionals with an outsized interest in California politics, policy and power. Subscribe today. | | | | | | | | | INVESTIGATING SUICIDE CLUSTERS — The CDC released guidance Tuesday to help public health officials more quickly identify and investigate suspected suicide clusters, or groups of suicides or attempts that happen close in time or location, Chelsea writes. Those events are rare, the guidance says, but comes as one of the agency’s priorities this year is to tackle a rise in suicide, CDC Director Mandy Cohen said last week. Suicide is among the 10 leading causes of death among people ages 10 to 64, according to the CDC. The report recommends forming a committee to investigate suspected clusters and the types of information to gather, including death certificates, law enforcement reports and emergency room data, and concludes with the recommendation to report findings publicly.
| | Mary Langowski has been named president of U.S. health care at Walgreens Boot Alliance. She was previously CEO of Solera Health. Rachel Weiss is now a senior adviser for external affairs at CMS. She previously was VP of advocacy for health care at Arnold Ventures.
| | Healthcare Dive reports on a lobby-funded study finding that CMS has underestimated the impact of proposed Medicare Advantage rates. The Wall Street Journal reports on the DOJ investigating UnitedHealth. The New York Times reports on how lead-tainted applesauce “sailed through gaps” in the system.
| | | | A message from Coalition for Medicare Choices: When 33 million beneficiaries renew their coverage in October 2024, they will be counting on stability in the savings, benefits and choices that are only available through Medicare Advantage. The combination of better care with lower out-of-pocket costs is why Medicare Advantage is such a valued choice for diverse and low-income beneficiaries, and a growing number of seniors in rural communities.
Stability is needed because there are far-reaching reforms to Medicare Advantage still being implemented, and big changes to seniors’ prescription drug coverage going into effect next year as well. Let’s make sure there’s no erosion in the benefits and affordability seniors and people with disabilities count on in Medicare Advantage. Protect Medicare Advantage. | | | | | | | Follow us on Twitter | | | | Follow us | | | | |
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