Thursday, July 29, 2010

AARP Pledges Support for Two House, One Senate Medicare Fraud-Fighting Bills

AARP endorsed three bills July 27, two in the House and one in the Senate, that focus on fighting Medicare fraud. The bills in question are the Medicare Fraud Enforcement and Prevention Act (H.R. 5044), a companion bill in the Senate (S. 3632), and the Fighting Fraud with Innovative Technology Act (H.R. 5546) (114 HCDR, 6/16/10).

H.R. 5044, sponsored by Reps. Ron Klein (D-Fla.) and Ileana Ros-Lehtinen (R-Fla.), would increase penalties for Medicare fraud, such as doubling monetary fines and doubling jail time.

H.R. 5044, would amend section 1128B of the Social Security Act, which governs criminal penalties for false statements involving federal health programs, removing the existing fine of $25,000 per claim and replacing it with a $50,000 fine per claim, and doubling jail sentences from five years to 10 years. Additionally, the bill would create new penalties for illegally purchasing, selling, or distributing Medicare or Medicaid beneficiary information, as well as billing information. Penalties for this violation would include up to three years in prison as well as monetary fines under Title 18 of the U.S. Code.

The bill would also establish a five-year pilot biometric program, designed to verify the identity of all Medicare beneficiaries. Upon receiving certain services or supplies, a beneficiary would have to undergo a biometric scan. The bill would allow the HHS secretary to create the list of services requiring a biometric test, and the secretary would be allowed to provide financial incentives to providers to take part in the pilot program.

Kevin G. McAnaney, an attorney with the Law Offices of Kevin G. McAnaney, Washington told BNA July 28 that the bill was a mixed bag, with some positive provisions, such as the penalties for selling Medicare beneficiary numbers, but several questionable sections.

“The bill would substantially expand the definition of ‘items and services' for purposes of civil monetary penalties from ‘medical care or services and items' to include ‘without limitation, any medical, social, management, administrative, or other item or service used in connection with or directly or indirectly related to a federal program',” McAnaney said.

H.R. 5546 would create a pre-payment review prevention system that would review Medicare claims, identifying high-risk claims using predictive modeling technology. All flagged claims would be fully reviewed by the HHS secretary, who would have the final say as to whether the claim was paid or denied. The system would work by assessing the risk level of all Medicare transactions on a near real-time basis and would identify suspicious patterns that increased the likelihood of fraud.

“I think this bill simply provides for a robust pre-payment review of claims akin to what the credit card companies do. I don't know if it will work, but it is certainly something they should be trying,” McAnaney said.

It should be made aware that these pieces of legislation highlight the fact that the House and Senate are continuously watching the Medicare program and taking measures to prevent fraud and abuse.

Swann, James. "AARP Pledges Support for Two House, One Senate Medicare Fraud-Fighting Bills." BNA Health Care Daily Report. 29 July 2010. Web. 29 July 2010.

No comments: