House, Senate Panels Look Into Ways To Combat Medicare Fraud
On Wednesday, House and Senate committees examined the rising incidence of Medicare fraud and sought potential solutions, Modern Healthcare reports (Zigmond, Modern Healthcare, 3/2).
House Energy and Commerce Subcommittee
The House Energy and Commerce Subcommittee on Oversight and Investigations examined a Government Accountability Office report that found the federal government made about $48 billion in improper payments for Medicare and Medicare Advantage in fiscal year 2010.
Kathleen King, director of the health care division at GAO, testified that the amount does not include improper payments made via the Medicare Part D prescription drug benefit.
The report stated that unless more action is taken to curb fraud, Medicare "is fiscally unsustainable in the long term" (Coughlin, Politico, 3/2).
Rep. Cliff Stearns (R-Fla.), chair of the Energy and Commerce subcommittee, criticized the use of estimates instead of exact numbers to convey how much the program loses every year to fraud schemes. Stearns said he is concerned about the forthcoming Medicare and Medicaid expansions under the federal health reform law when "it is still unclear how much is lost."
King recommended that CMS establish or improve various antifraud initiatives, such as:
- Implementing an effective system for physician profiling;
- Managing payments for services;
- Developing policies to improve oversight of program contracts;
- Reviewing specific claims for services with high rates of improper billing; and
- Supervising nursing homes with serious care problems (Modern Healthcare, 3/2).
House Ways and Means Subcommittee
Meanwhile, America's Health Insurance Plans President and CEO Karen Ignagni testified before the House Ways and Means Oversight Subcommittee and provided four additional measures to curb fraud:
- Emphasizing fraud prevention and credentialing activities in quality improvement efforts;
- Enhancing data sharing between the public and private sectors of Medicare;
- Including components of public and private sector programs in federal fraud cases; and
- Strengthening protections for private health plans that supply information to any public or private entity on individuals suspected of fraud.
Lewis Morris, chief counsel to HHS' Office of Inspector General, testified to the Oversight Subcommittee that Medicare fraud in both the public and private sectors could total as much as $100 billion (Modern Healthcare, 3/2).
Senate Finance Committee
On Wednesday, the Senate Finance Committee held a similar hearing on Medicare fraud, during which chair Max Baucus (D-Mont.) called for quarterly reports from federal investigators on their progress in combating fraud(Adams, CQ HealthBeat, 3/2).
Further, Sens. Ron Wyden (D-Ore.) and Chuck Grassley (R-Iowa) pushed legislation that would end rules that have been in effect since the 1970s that keep information regarding Medicare reimbursements off-limits to the public. They believe publicizing the payments could help reveal major fraud operations.
The American Medical Association opposes the proposal, saying it would violate physicians' privacy and cause some doctors to leave the program.
AMA President Cecil Wilson said in a statement that "studies have demonstrated that physicians are not a significant source of Medicare fraud" (Pecquet , "Healthwatch," The Hill, 3/2).
Grassley also asked Levinson to investigate possible ties between the Cuban government and Medicare fraud in south Florida. Grassley cited a report from the Institute for Cuban and Cuban-American Studies at the University of Miami that questioned the involvement of Fidel Castro's regime in Medicare scams (Pecquet , "Healthwatch," The Hill, 3/2).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.