Feb. 5 — Recommendations from more than 160 healthcare stakeholders on ways to improve federal efforts to combat waste, fraud, and abuse in the Medicare and Medicaid programs were released in a report compiled by six current and former members of the Senate Finance Committee last Friday. 

The committee, led by ranking member Orrin Hatch (R-Utah) and Chairman Max Baucus (D-Mont.), compiled the recommendations from white papers submitted in response to an invitation the committee issued last May.

Recommendations include the following:

  • Increasing federal funding of state Medicaid anti-fraud activities
  • Eliminating duplication and redundancy in federal and state Medicare/Medicaid anti-fraud programs (both specific programs and generally)
  • Changing certain Medicare payment policies that, through disparate pricing issues, lead to fraud, waste, and abuse
  • Ensuring that provider enrollment policies are consistent and used effectively
  • Requiring the Center for Medicare & Medicaid Services (CMS) to use existing statutory authorities (for example, moratorium, mandatory compliance programs) not yet used
  • Clarifying the circumstances in which use of care and the setting for care is appropriate, such as when to use inpatient care versus outpatient
  • Making process changes to ensure CMS audit contractors operate efficiently and effectively
  • Balancing incentives for Medicare contractors to identify overpayments with penalties for contractors whose findings are overturned on appeal through the CMS administrative process
  • Creating an advisory panel to provide clinical input as a component of contractor oversight

The senators’ staff now will work with key committees of jurisdiction, the Government Accountability Office, the U.S. Department of Health and Human Services Office of the Inspector General, and interested stakeholders to develop a more detailed list of administrative recommendations and potential legislative actions.

Joining Hatch and Baucus on the report, titled “Opportunities to Curb Waste, Fraud and Abuse in Medicare and Medicaid,” are Senators Tom Coburn (R-Okla.), Ron Wyden (D-Ore.), Chuck Grassley (R-Iowa), and Tom Carper (D-Del.).

Publication Date: Tuesday, February 05, 2013