Cardiothoracic surgeon and TV personality Mehmet Oz, MD, MBA, appeared to be on track Friday for Senate confirmation as the next CMS administrator, if his friendly conversations with both Democratic and Republican Senate Finance Committee members were any indication.
Sen. Elizabeth Warren (D-Mass.) brought up the issue of Medicare Advantage plans that have been padding patient records with extra diagnoses in order to get higher per-patient payments from Medicare.
“We are, I think, as an agency aware of this,” Oz said. “If confirmed, this will be one of the topics that is relatively enjoyable to go after, because I think we have bipartisan support.”
“I love hearing this,” Warren responded. She went on to discuss the House Republicans’ proposal to cut $880 billion from the budget over 10 years, much of which is likely to come from the Medicaid program. “I have a simple question: if you have the choice, would you rather cut waste, fraud, and abuse by a Fortune 50 health insurance company in Medicare Advantage, or cut funding for Medicaid, which covers all seniors in nursing homes and one in three of America’s children?”
“My goal is to improve the healthcare of the American people, and as you create the argument, the former sounds like a more rational way to do that,” Oz said.
Sen. Raphael Warnock (D-Ga.) asked Oz for his thoughts on Georgia’s work requirement program for Medicaid — which has been implemented through a CMS waiver — that requires beneficiaries each month to prove that they’re working, volunteering, or in school so that they can continue getting their Medicaid benefits. “Do you think a family should have to fill out paperwork every month just to get healthcare?” Warnock asked.
“I don’t think you need to use paperwork to prove a work requirement, and I don’t think that should be used as an obstacle, a disingenuous effort to block people from getting on Medicaid,” Oz said. “However, I believe we both probably believe there’s value in work, and it doesn’t have to be going to a job — it could be getting education, it could be showing that you want to contribute to society.”
Sen. Bill Cassidy, MD (R-La.), asked Oz what should be done about the excessive use of prior authorization in the Medicare Advantage program. “This issue of preauthorization is a pox on the system,” Oz said; he used the word “preauthorization” throughout the hearing. “Preauthorization is misused in some settings, [although] there needs to be a mechanism to confirm that procedures are worthwhile.”
While Medicare pays for about 15,000 services and procedures that could be subject to prior authorization, “insurance companies today use preauthorization for about 5,500 of those procedures — but interestingly, not all insurance companies focus on the same things, and even within the same procedure, the criteria for accepting it are also all over the place,” Oz continued. “So it’s very difficult to automate that, and so it tends to be misused because it stalls the process” of approval and payment.
He suggested that Medicare limit the number of procedures requiring prior authorization to 1,000 “and be very clear — if you’re going to have a knee replacement and you can bend your knee more than 120 degrees — or whatever number you want to put in there — you don’t get to get the knee replacement,” he said. “And then, if we know those [criteria] ahead of time, just like a credit card approval doesn’t take you 3 months, you know immediately whether the transaction is approved or not. We will be able to do something similar, so that preauthorization could happen rapidly.”
Not every interaction was positive, however. Sen. Maggie Hassan (D-N.H.) asked Oz a question she has been asking of all Trump administration nominees: “If directed by the president to take action that would break the law, would you follow the law or follow the president’s directive?”
“The president would never do that,” Oz said.
“That’s absurd, and it’s a disappointing answer,” said Hassan. She went on to ask Oz about whether he still believes in the various supplements and remedies he promoted on “The Dr. Oz Show,” including green coffee bean extract and raspberry ketones. With regard to the latter, Hassan noted that Oz claimed that it is “‘a No. 1 miracle in a bottle to burn your fat.’ That’s your quote. Will you confirm for the record today that you no longer believe raspberry ketones to be a ‘miracle in a bottle?'”
Oz did not respond directly. “There are many things I said in the show,” he said. “I take great pride in the research we did at the time to identify which of these worked and which ones didn’t. Many of them are still being researched, like the green coffee bean extract you just mentioned.”
Hassan seemed unhappy with that response. “You have been nominated to run the set of largest health programs in the United States of America, and it seems to me you are still unwilling to take accountability for your promotion of unproven snake oil remedies to millions of your viewers. And that’s really concerning,” she said.
Sen. Ron Wyden (D-Ore.), the committee’s ranking member, mentioned in his opening statement a memo from the Finance Committee’s minority office which found that Oz took advantage of a tax loophole, allowing him to get out of paying $440,000 in Social Security and Medicare taxes over the last 3 years. “So what that means is the person who’s nominated to run Medicare thinks that it’s acceptable to not pay his taxes into Social Security and Medicare — like nurses and firefighters do out of every paycheck,” said Wyden.
The Finance Committee must vote on Oz’s nomination before it can advance to the Senate floor; all indications are that the committee will recommend Oz’s approval. The date of the committee vote is uncertain, with the Senate in recess next week.
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