New Bill Raises Ante in Crackdown on Medicare Fraud

MIAMI — Speaking at the Little Havana Senior Activity
Center April 13, Reps. Ron Klein, D-Fla., and Ileana Ros-Lehtinen,
R-Fla., announced a new bill they say would rein in Medicare
fraud.

The Medicare Fraud Enforcement and Prevention Act of 2010
(MFEPA) would update both the false statements and anti-kickback
statues in the Social Security Act, doubling criminal penalties
from five years to 10 and increasing fines from $25,000 to $50,000.
It would also hone in on illegal distribution of Medicare or
Medicaid IDs — and supplier billing numbers — setting a
three-year jail term for those offenses.

The bill would implement criminal background checks,
fingerprinting and random site visits for “high-risk” providers to
ensure they are legitimate businesses “before they get the first
check,” Klein told the ThePalm Beach Post. But he also
said that “fraud prevention should not inconvenience legitimate
health care providers” and believes “safeguards against fraud could
be enforced without lengthening the normal 14-day period in which
Medicare pays providers,” wrote Post reporter John
Lantigua.

The proposed legislation also calls for a pilot program that
would utilize biometrics (technologies include such things as
recognition from fingerprints and eye scans) to verify physician
visits. The nation’s new health reform law requires a face-to-face
physician exam for all HME equipment and supplies billed to
Medicare.

In addition, the bill directs the Government Accounting Office
to study Medicare contractors, including Recovery Audit
Contractors, and report back to Congress with recommendations for
action on identifying fraud, and whether CMS should be giving more
training to contractors or requiring contractors to hire experts
with more medical training.

“The best way to save seniors and taxpayers money while keeping
Medicare strong is to get tough on criminals and stop crimes before
they start — and that is why our bill does both,” Klein said,
adding that MFEPA “will help ensure that crooks can no longer open
fake businesses or submit false paperwork to steal tens of billions
of dollars a year from senior citizens and taxpayers.”

South Florida, which has been dubbed Gound Zero for Medicare
fraud, makes up nearly 20 percent of all Medicare fraud nationwide,
Klein said.

In its Wednesday newsletter, the American Association for
Homecare pointed out the new bill (H.R. 5044) reflects many of the
points “that AAHomecare has been pounding in Washington for years”
and several of the provisions proposed in the association’s
13-point
anti-fraud legislative action plan, which was presented to
Congress in early 2009.

The North Carolina Association of Medical Equipment Services
also issued a statement lauding the new bill after its
introduction.

“Getting tough on criminals is much more effective than
rationing access to home health care through restrictive Medicare
bidding rules, which is not stopping criminals from bilking the
system and is threatening the livelihood of hundreds of reliable
HME service providers in North Carolina,” said Beth Bowen, NCAMES
executive director. “It’s time the government takes responsibility
for policing their own program rather than trying to shut down
honest, hardworking small businesses and harm patient access and
patient choice.”

The text of the Medicare Fraud Enforcement and Prevention Act
should be available soon at http://thomas.loc.gov.