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New Legislation Proposed to Prevent Medicare Fraud
By
Michael A. Piekarz
Staff Writer
Catching
criminals, stopping Medicare or Medicaid fraud, and recapturing an
estimated yearly fraud loss of $60 billion are the aim of two proposed
laws introduced in the U.S. Senate earlier this month.
The Seniors and Taxpayers Obligation Protection Act (STOP) is designed to reduce
or eliminate massive financial losses each year by creating fraud prevention
and detection systems.
The Medicaid Accountability through Transparency Act (MAT) will require transparency
in billing for services and medical equipment.
If passed, the legislation will give the Centers for Medicare & Medicaid
Services (CMS), the Department of Health and Human Services (HHS) and the Social
Security Administration the tools and authority to prevent fraud before it starts
and detect waste and abuse much earlier.
The two bills were introduced by Senators Mel Martinez, R-Fla., and John Cornyn,
R-Texas.
“Each year, criminal fraud in Medicare and Medicaid diverts billions away
from programs that care for our nation’s 43 million seniors and disabled
persons,” Martinez, ranking member of the Senate’s Special Committee
on Aging, proclaimed. “We need a proactive approach to tackle this problem,
and that begins with efforts to bring transparency to the system and common sense
efforts to detect and prevent fraud.”
The language of the proposed STOP Act requires the Secretary of HHS to implement
changes to the current system of using Social Security numbers as the Medicare
Beneficiary Identifier on Medicare cards in order to reduce fraud and identity
theft among seniors.
“These steps will help protect seniors and doctors from identity theft,
keep criminals from becoming Medicare providers, and strengthen data mining and
matching to catch criminals currently in Medicare in real time,” explained
Martinez.
The STOP Act also improves HHS’s detection methods and places billing statements
under increased scrutiny. Items such as durable medical equipment are often falsely
billed at taxpayer expense — usually by fake companies with nothing more
than a P.O. Box.
“This legislation takes a big step in preventing Medicare fraud and abuse,
which costs taxpayers up to $60 billion each year, and it will help [to] ensure
that Medicare spending is actually reaching Medicare patients,” said STOP
Act cosponsor Sen. Lamar Alexander, R-Texas, a member of the Senate Committee
on Health, Education, Labor and Pensions.
If passed, the MAT Act will reduce the prevalence of fraud in the Medicaid program
by requiring HHS to publicly disclose the Medicaid payment data it already collects
through the establishment of a publicly-accessible Web site containing non-aggregated
Medicaid claim payment data in compliance with existing medical record privacy
laws.
The information on the Web site will be provided in a format that is easily accessible,
useable and understandable to the public, and it will be updated at least once
per calendar quarter.
By disclosing Medicaid payment data, it is hoped that the new law will protect
American taxpayers by reducing waste, fraud and abuse.
“Americans expect better fiscal management from their government, and this
legislation helps stop the loss and waste of our already-strained Medicare funds
by also providing fraud protection and prevention mechanisms for our seniors,” explained
Sen. David Vitter, R-La.
Lawmakers noted that the MAT Act should allow the proper authorities to prosecute
fraud cases without compromising the identity of Medicaid beneficiaries.
To ensure compliance, the bill imposes a penalty of $25,000 per day for any period
in which the Secretary of HHS has found a state to have not fully and properly
complied with the requirements for data collection associated with the Medicaid
Statistical Information System.
“Medicare fraud and abuse not only wastes an estimated $60 billion a year
of taxpayer dollars, it hurts legitimate providers and Medicare recipients,” said
Cornyn. “This legislation will better detect and prevent abuse of the system
to stop Medicare fraud before it starts. I urge my colleagues to support this
important measure so we can strengthen protections for taxpayers and those who
depend on Medicare.”
Further action on the two bills is expected later in the year.
This page and its contents ©2009
Metropolitan News Company, Inc.
