Thursday, February 28, 2013

Senate Finance Committee Takes
In-Depth Look at Fraud & Abuse

Earlier this week, I discussed the HHS and DOJ Annual Report for the Health Care Fraud and Abuse Program.  HHS and DOJ are not the only ones determined to purge the health care industry of its woes.   On January 31, 2013, a group of six current and former members of the Senate Finance Committee released a comprehensive report detailing recommendations on combating waste, fraud and abuse in the Medicare and Medicaid Programs.

The Committee, which has jurisdiction over Medicare and Medicaid, is led by current Chairman Max Baucus (D-MT) and Ranking Member Orrin Hatch (R-UT). They were joined by Senators Tom Coburn (R-OK), Ron Wyden (D-OR), Chuck Grassley (R-IA) and Tom Carper (D-DE). Together this group solicited recommendations from 164 health care industry experts across the country. According to Baucus, the Committee received over 2,000 pages of input and ideas from the nation’s health care community, which offered common sense solutions to strengthen Medicare and Medicaid.

The work for the report started last May when the bipartisan group of lawmakers invited interested stakeholders to submit white papers offering recommendations and innovative solutions to improve program integrity, strengthen payment reforms, and enhance fraud and abuse enforcement tools. Some of the suggested changes to the system include:

  • Increasing state Medicaid anti-fraud program funding;
  • Requiring the Centers for Medicare and Medicaid Services (CMS) to use currently un-utilized statutory authorities, such as mandatory compliance programs;
  • Clarifying appropriate settings for care (inpatient vs. outpatient, for example);
  • Eliminating duplicative federal and state Medicare/Medicaid anti-fraud programs; and
  • Creating an advisory panel to provide clinical input as a component of contractor oversight.

The Committee’s work is not over. They intend to work with key Committees of jurisdiction, the Government Accountability Office (“GAO”), and the Department of Health and Human Services Office of the Inspector General (“HHS-OIG”) and industry stakeholders to develop a more detailed list of recommendations and actions. It is notable that some of the suggested changes are within CMS’ authority and will not require legislation.

Regardless of what side of the aisle they are on, it appears lawmakers are committed to improving Medicare and Medicaid for the taxpayers. The report, according to Senator Wyden, represents what can be accomplished when Senators work together with the private sector.

Christopher J. Shaughnessy
McBrayer, McGinnis, Leslie & Kirkland, PLLC
Lexington, Kentucky

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