Next week, Health & Human Services Secretary Xavier Becerra will face heat from lawmakers when he defends his Fiscal Year 2025 budget in front of Congress. He’s asking for trillions of dollars when the federal government is spending 38% more than it takes in and his own department loses well over $100 billion to improper payments and fraud each year.
That’s election-year red meat for Republicans. But Democrats may also point to business fraud as the culprit for 73% of Americans despairing about Medicare’s future.
Becerra’s probably ready to take the partisan blows; he’s no rookie to Capitol Hill. But he can also do a lot more, and set a new standard for modern politics: use a proven crisis communications framework to take responsibility for misspending, present concrete plans for improvement, and establish metrics of success to which he can be held accountable.
Shouldering blame is the first and hardest step; Becerra will likely be dragged through the mud on and off the Hill. And it’s not all his fault; HHS has spent decades failing to steward taxpayer money. But the job of a Cabinet secretary is to manage and improve - not to point fingers or kick the can down the road. Taking accountability will impress a lot of people who are used to ducking and dodging.
And dodging is no solution. Last year’s $104 billion in improper Medicare and Medicaid payments is only the tip of the HHS trust deficit iceberg. Becerra’s agency also acknowledged $3.18 billion in fraud adjudicated by the U.S. Department of Justice. But even these shocking numbers don’t account for everything, such as state-adjudicated fraud and fraud settlements without blame; or departments inside HHS that the law exempts from improper payments investigations.
No wonder most Americans don’t expect to see a good return on their “investment” in Medicare.
Second, he needs to work with Congress to implement concrete plans to improve the quality of services and stewardship of taxpayer money. Independent agencies like the Government Accountability Office (GAO) have already offered promising solutions. For example, 16 states already have their own version of the Federal False Claims Act, which aligns federal and state incentives. This means 34 others can follow suit.
Better information is also critical to improving financial stewardship. A lot of HHS’ misspending comes down to a lack of oversight, like claims being paid before a health care provider submits proper paperwork. Becerra can ask Congress to pass legislation giving CMS’ recovery auditors authority to review claims before they are paid. And he can also direct Centers for Medicare and Medicaid Services Administrator Chiquita Brooks-LaSure to curb double-dipping for uncompensated hospital care.
Third, Becerra should publicly establish meaningful metrics of success, with accountability throughout all of HHS - starting at the top. The upcoming hearing should be just the first part of a long-term, bipartisan effort that will include more hearings, legislation, data points about improvements, and internal agency changes. Becerra will also need to publicly establish meaningful metrics of success, with accountability throughout all of HHS - starting at the top.
Skepticism of our government is at an all-time high, and Congress often translates constituent anger into bludgeoning during hearings. Trust won't be easy to rebuild. But saving taxpayers over tens of billions of dollars annually covers a multitude of sins…and it will probably result in better care for millions who rely on Medicare and Medicaid every day. On top of that, it will rebuild fidelity and goodwill among the agency, Congress, and voters.
The only other “solution” is to keep kicking the can down the road. Becerra certainly could do that, as his predecessors have. But maybe he can be persuaded to break off from a long line of forgettable and forgotten Cabinet secretaries, and instead aim to be a leader who makes a once-in-a-generation difference.
Kelly Ferguson is Director of Public Affairs for Proven Media Solutions. She is a former healthcare lobbyist and congressional staffer. Dustin Siggins is founder of Proven Media Solutions and a former Capitol Hill reporter.
