CMS Unveils Final Rule Targeting Fraud, Waste in Medicare Part D
On Monday, CMS issued a final rule designed to combat fraud and waste in Medicare Part D and reduce spending by as much as $1.6 billion in the program over 10 years, in part by requiring physicians who prescribe drugs through the program to enroll in Medicare or file for an exemption, The Hill reports (Viebeck, The Hill, 5/19).
The rule is scheduled to take effect on June 1, 2015, roughly five months later than initially scheduled in the agency's proposed rule.
According to Modern Healthcare, the rule also will authorize CMS to strip providers of their ability to enroll in Medicare if the Drug Enforcement Administration has revoked their certification to prescribe controlled substances. The agency will also be able to revoke physicians' enrollment privileges if they have been prescribing medications in a way that threatens the health of patients. Such penalties will only be applied in situations where drug misuse is well-documented (Demko, Modern Healthcare, 5/19).
In addition, the rules will expand the release of unencrypted, prescriber, insurer and pharmacy identifiers listed in prescription drug records. According to CQ HealthBeat, the expansion will give the public more access to the data while simultaneously protecting the privacy of Medicare beneficiaries (Young, CQ HealthBeat, 5/19).
Experts: Bundled Payments, ACOs Could Stem Medicare Fraud
In related news, lawmakers and health policy experts are continuing to press for wider adoption of a bundled payment approach in health care as a strategy to reduce fraud and abuse in Medicare, USA Today reports.
For example, Sen. Elizabeth Warren (D-Mass.) during a committee hearing earlier this month noted that the Congressional Budget Office has estimated that a bundled payment system "could save Medicare about $46.6 billion over the next seven years."
Such payment systems have garnered financial success in Massachusetts, and a CMS-led accountable care organization pilot program, rolled out under the Affordable Care Act with 114 participants, saved nearly $380 million in 2013.
The pharmaceutical industry has lobbied against the changes. Randy Burkholder, vice president for policy and research at Pharmaceutical Research and Manufacturers of America, said that there are "a lot of challenges and a lot of issues around how ACOs and bundled payments get structured."
He said that such payment systems would have to be "appropriately structured" to ensure that physicians and patients can select the most effective medication (Kennedy, USA Today, 5/19).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.