Obama’s Proposed Health Care Reform Takes Strong Aim At Fraud

In what looks like an effort to try to appeal to some Republican members of Congress, or at least one, President Obama’s health care proposal, released earlier today, takes aim at health care fraud. The proposal talks about saving $100 billion over the next decade, and about $1 trillion over the second decade, by “cutting government overspending” and reining in “waste, fraud and abuse.” It’s not clear at this point exactly how much of those savings is attributable to fraud (we hope it’s not the largest portion), but certainly health care fraud is a continuing target of the Obama administration.

Here are the key steps in the proposal that are intended to fight fraud:
 
O         Comprehensive Sanctions Database.
The president’s proposal establishes a comprehensive Medicare and Medicaid sanctions database, overseen by the HHS Inspector General.  This database will provide a central storage location, allowing for law enforcement access to information related to past sanctions on health care providers, suppliers and related entities.  
O         Registration and Background Checks of Billing Agencies and Individuals.
In an effort to decrease dishonest billing practices in the Medicare program, the president’s proposal will assist in reducing the number of individuals and agencies with a history of fraudulent activities participating in federal health care programs.  It is intended to ensure that entities that bill for Medicare on behalf of providers are in good standing.  It also strengthens the Secretary’s ability to exclude from Medicare individuals who knowingly submit false or fraudulent claims. 
O         Expanded Access to the Healthcare Integrity and Protection Data Bank. 
The president’s proposal broadens access to the health care integrity data bank to quality control and peer review organizations and private plans that are involved in furnishing items or services reimbursed by Federal health care program.  It includes criminal penalties for misuse. 
O         Liability of Medicare Administrative Contractors for Claims Submitted by Excluded Providers.
The proposal holds Medicare Administrative Contractors accountable for federal payment for individuals or entities excluded from the federal programs or items or services for which payment is denied. 
O         Limiting Debt Discharge in Bankruptcies of Fraudulent Health Care Providers or Suppliers.
The proposal prevents fraudulent health care providers from discharging through bankruptcy amounts due to the federal government from overpayments.
O         Use of Technology for Real-Time Data Review.
The proposal speeds access to claims data to identify potentially fraudulent payments by establishing a system for using technology to provide real time data analysis of claim and payments under public programs to identify and stop waste, fraud, and abuse. 
O         Illegal Distribution of Medicare or Medicaid Beneficiary Identification or Billing Privileges. 
According to the administration, fraudulent billing to Medicare and Medicaid programs costs taxpayers millions of dollars each year.  Individuals looking to gain access to a beneficiary’s personal information approach Medicare and Medicaid beneficiaries with false incentives.  Many beneficiaries unwittingly give over this personal information without ever receiving promised services.   The proposal adds sanctions, including jail time, for individuals who purchase, sell or distribute Medicare beneficiary identification numbers or billing privileges under Medicare or Medicaid – if done knowingly, intentionally, and with intent to defraud.
O         Study of Universal Product Numbers Claims Forms for Selected Items and Services under the Medicare Program.
The proposal requires HHS to study and issue a report to Congress that examines the costs and benefits of assigning universal product numbers (UPNs) to selected items and services reimbursed under Medicare. The report must examine whether UPNs could help improve the efficient operation of Medicare and its ability to detect fraud and abuse.
O         Establish a CMS-IRS Data Match to Identify Fraudulent Providers. 
The proposal authorizes the Centers for Medicare & Medicaid Services (CMS) to work collaboratively with the Internal Revenue Service (IRS) to determine which providers have seriously delinquent tax debt to help identify potentially fraudulent providers sooner. The data match will primarily target certain high risk provider types in high vulnerability areas. This proposal also enables both IRS and Medicare to recoup any monies owed to the Federal government through this program. By requiring the IRS to disclose to CMS those entities that have evaded filing taxes and matching the data against provider billing data, this proposal will enable CMS to better detect fraudulent providers billing the Medicare program.