Senators Get STOP Act Started Again

WASHINGTON — Sens. Mel Martinez, R-Fla., and John Cornyn, R-Texas, are trying again with the STOP Act and an accompanying bill aimed at preventing and stopping Medicare and Medicaid fraud.

On Tuesday, Martinez and Cornyn re-introduced the Seniors and Taxpayers Obligation Protection (STOP) Act< (S. 975), which they said would give federal agencies the tools they need to crack down on Medicare fraud before it occurs. The senators had introduced the bill last June, but no action was taken. (See STOP Act Aims to Curb Medicare Fraud, August 4, 2008.)

An accompanying measure called the Medicaid Accountability through Transparency, or MAT, Act (S. 974) will require transparency in billing for services and medical equipment.

Together, the two bills will help to improve HHS’ detection methods and place billing statements under increased scrutiny, Martinez said.

“Entitlement program fraud is out of control,” said Martinez, ranking member of the Senate’s Special Committee on Aging. “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. Especially in this time of limited resources and efforts to find savings, starting with the largest fraud makes sense. We need a proactive approach to tackle this problem, and that begins with efforts to bring transparency to the system and commonsense efforts to detect and prevent fraud.”

On Wednesday, Martinez chaired a hearing on the subject with a number of witnesses, including R. Alexander Acosta, U.S. Attorney for the Southern District of Florida, an area where the Medicare Fraud Strike Force — a combination effort by the FBI, HHS’ Office of Inspector General and local law enforcement — has been active.

Acosta called the task force results “both sad and spectacular.” Operating since 2006, the anti-fraud force has brought cases against more than 700 individuals responsible for billing Medicare more than $2 billion. However, Acosta told the committee, “Prosections are not the answer.” The best way to prevent Medicare fraud, he said, is “to implement systemic changes at CMS ??? that are designed to identify and deny fraudulent bills.”

Among other measures, the STOP Act would require real-time analysis of claims data (similar to that used in the analysis of credit card charging patterns) to identify unusual billing or ordering practices that could indicate fraud or abuse.

The American Association for Homecare issued a statement applauding the STOP Act, which contains a number of points that mirror the association’s recommendations for stopping fraud. Those points include both pre-enrollment and unannounced site visits for new HME providers; site visits for current providers that are re-enrolling, as well as an unannounced site visit after re-enrollment; and checks to ensure the provider is qualified and enrolled to bill the type of item or service on the claim.

Last year, AAHomecare presented its 13-point anti-fraud plan to Congress. (See AAHomecare Offers 13-Point Plan to Stop Medicare Fraud, Oct. 27, 2008.)