Chairman James Comer of the House Committee on Oversight and Government Reform raised concerns on Apr. 30 about the complexity of the federal billing system used for Medicare and Medicaid, warning it may be contributing to improper payments and higher healthcare costs. In a letter to Centers for Medicare and Medicaid Services (CMS) Administrator Mehmet Oz, Comer requested a staff-level briefing on CMS oversight of the Current Procedural Terminology (CPT) code system.
The issue matters because billions of taxpayer dollars are spent each year based on this billing framework, which is mandated by the federal government. Critics say its lack of transparency could enable waste, fraud, or abuse in major public health programs.
“The Committee on Oversight and Government Reform is continuing to investigate the drivers of rising healthcare costs in federal programs, including systemic issues that may enable waste, fraud, and abuse. The Current Procedural Terminology (CPT) code system mandated by the federal government as the standard for billing Medicare and Medicaid plays a central role in determining how billions of taxpayer dollars are spent each year. The complexity of this system may be contributing to improper billing and higher costs for patients and taxpayers,” wrote Chairman Comer.
Comer also said there are “fundamental questions about transparency, cost control, and whether federal healthcare policy is shaped in the best interest of patients, or by entities with financial incentives tied to the system’s continued complexity.” He called for more information from CMS regarding its authority over CPT codes—created by the American Medical Association—and whether alternatives might reduce administrative burdens.
He cited findings from government watchdogs showing hospital billing at high severity levels has increased nearly 20 percent between fiscal years 2014-2019 while billions have been recovered annually through fraud settlements. “Given these concerns, the Committee seeks to better understand whether the structure and complexity of the CPT system drives unnecessary costs in federal healthcare programs and what steps CMS is taking to protect taxpayers,” continued Chairman Comer.
In closing his letter, Comer referenced past efforts such as banning unlinked chart reviews—which aimed at saving $7 billion per year—and stressed that real-time fraud detection remains critical but vulnerabilities persist outside certain managed care organizations.
