Anti-Fraud Proposals Proliferate

WASHINGTON — In the current Capitol Hill environment,
according to Cara Bachenheimer, “combating fraud, waste and abuse
is motherhood and apple pie.”

A recent flurry of bills addressing the issue highlight the
point:

• Introduced Nov. 16 by Sen. Chuck Grassley, R-Iowa, the Fighting
  Medicare Payment Fraud Act of 2009 (S. 2774) would give Medicare
  more time to pay a claim if it believes the claim is fraudulent.
  The bill proposes a payment extension of up to one year for
  categories of providers or suppliers in a particular geographic
  area, or for individual providers if it is determined there is a
  likelihood of fraud, waste or abuse. (For more, see Grassley: Check for
  Fraud before Paying Claims, Nov. 18.)

• The Prevent Health Care Fraud Act of 2009 (S. 2128), introduced
  Oct. 29 by Sen. George LeMieux, R-Fla., is a reintroduction of
  legislation proposed in May by Sen. Mel Martinez, R-Fla., who
  recently resigned his seat. The bill calls for creation of a Chief
  Healthcare Fraud Prevention Office and also incorporates some of
  the provisions in the American Association for Homecare’s 13-point
  plan to curtail fraud and abuse, which the group recommended to
  lawmakers in February. Among others, those points include
  better screening of providers before enrollment, site visits during
  renewal and real-time analysis of claims data, similar to that used
  in the analysis of credit card charges, to pinpoint billing
  patterns that could indicate fraud or abuse.

• On Oct. 28, Sen. Ted Kaufman, D-Del., introduced the Health Care
  Fraud Enforcement Act of 2009 (S. 1959). The bill is aimed at
  bolstering the government’s ability to investigate and prosecute
  cases of fraud, waste and abuse by stiffening sentences and
  broadening authority. It would also increase funds to fight fraud
  by $20 million annually from 2011 to 2016.

In addition, both the House and Senate health care reform bills
contain anti-fraud measures, although many of them wouldn’t
necessarily help in fighting the problem, said Bachenheimer, senior
vice president of government relations for Elyria, Ohio-based
Invacare.

“The health bills in both chambers contain numerous provisions
to address these problems, many of which we agree with, though some
that are well-intended [will] not meaningfully address fraud and
abuse,” she said, “e.g., a face-to-face exam required for any items
of DME a physician prescribes.”

Seth Johnson, vice president of government affairs for Pride
Mobility Products, Exeter, Pa., said the Grassley bill falls into
the same category.

“The Grassley bill … would do little to address the
heart of the Medicare fraud problem within the DME industry, which
is CMS providing Medicare supplier numbers to shell companies that
have no intention of complying with the current Medicare
requirements,” he said.

“In the end,” said Bachenheimer, “if the government can’t
effectively operate the Medicare billing number gatekeeper
function, these other types of hurdles likely just harm compliant
providers.”