Legislative Update: March 2012

Legislative Update: March 2012

Administration Making Efforts To Rein In Medicare Fraud

By Jarrad Hensley, TSCL Legislative Assistant

Medicare fraud, abuse, and wasteful spending are problems that continue to affect all Americans. Attorney General Eric Holder estimates that fraudulent Medicare activities cost taxpayers an estimated $60 billion a year. The staggering figure has contributed to rising costs that are passed on to beneficiaries. Lawmakers and administrators are seeking alternative measures to reign in Medicare’s out-of-control costs to seniors.

Needless to say, the Centers for Medicare and Medicaid Services (CMS) still lacks the effective oversight to monitor the wasteful payments that continue to plague the system. The Obama administration has made efforts to increase Medicare’s accountability and reign in the waste and fraud that remain at an all time high level. In an education initiative, President Obama recently announced an increased effort and funding for a “Senior Medicare Patrol” program designed to educate Medicare beneficiaries on fraudulent spending from healthcare providers. The goal is to bolster Medicare fraud education programs for seniors across the country, highlighting ways to spot and report suspicious fraudulent activity from healthcare providers.

CMS has also partnered with the Department of Justice to help to increase law enforcement efforts for Medicare fraud and abuse. In 2009, the Health Care Fraud Prevention and Enforcement Action Team was established to provide a law enforcement arm to the government’s effort to stem the tide of Medicare fraud and abuse perpetrators. The special task force combines authorities from local, state, and the Department of Justice and Health and Human Services agencies to increase communication and shared investigative techniques.

Perhaps the most ambitious effort on behalf of the Obama administration to fight Medicare fraud, abuse, and wasteful spending is the Medicare Shared Savings Program (MSSP). The program will use networks of doctors, hospitals and other healthcare providers that form a partnership to provide increased accountability toward savings. MSSP is administered by CMS and will aim to bring together in partnerships up to 270 physicians, specialists, hospitals, and long-term care facilities across the country to participate in the program. If effective, the program will reduce healthcare costs by eliminating wasteful and inefficient practices (misdiagnoses and increased oversight) that could save Medicare an estimated $940 million over the next four years.

The Senior Citizens League (TSCL) believes that these CMS initiatives to fight Medicare fraud, waste, and abuse are encouraging steps toward containing and even preventing escalating costs and premiums. However, more steps like Representative Ileana Ros-Lehtinen’s (FL-18) TSCL-supported Medicare Fraud Prevention Fraud Enforcement and Prevention Act should be taken. If passed, this bill would create a pilot program using biometric technology to ensure that all Medicare claims are legitimate. It would also facilitate real-time information sharing between law enforcement agencies, and it would increase the penalties for those convicted of Medicare fraud. While wasteful and fraudulent activities aren’t the only issues of Medicare reform, TSCL believes that strict oversight from lawmakers, administrators, and seniors alike is a proper first step.