Efforts to repeal the Affordable Care Act (ACA) could end up taking away critical provisions designed to fight Medicare fraud, Democrats said during a House Ways and Means Oversight Subcommittee hearing on Tuesday.
Rep. Suzan DelBene, D-Wash., pointed to several antifraud provisions included in the law, including a requirement that plans, providers, and suppliers report and return overpayments within 60 days of receipt. The ACA also requires physicians to document referrals to highly abused programs and allows federal authorities to penalize beneficiaries for knowingly participating in fraudulent schemes, she said. If states succeed in their legal battle to overturn the law in its entirety, DelBene argued, the government will lose numerous fraud prevention tools.
The ACA also strengthened sentencing guidelines for fraudsters and provided funding for the Medicare Fraud Strike Force program, which has helped coordinate national fraud takedowns with the Department of Justice. In its most recent takedown last month, the DOJ charged more than 600 individuals with healthcare fraud schemes worth $2 billion.
Rep. Earl Blumenauer, D-Ore., echoed those concerns, calling on the Trump administration to take the provisions DelBene mentioned seriously, “unlike some of the other areas, where they appear to be taking apart the Affordable Care Act bolt-by-bolt, destabilizing the system, and making things worse.”
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Notable questions and comments arose from the other side of the aisle as well, though not relating to the ACA. Rep. Brad Wenstrup, R-Ohio, illustrated the need for authorities to differentiate between “innocent miscoding and intentional overcoding” with two stories from his days as a podiatrist.
Wenstrup did not receive a direct answer from Alec Alexander, deputy administrator and director of the Centers for Medicare and Medicaid Services' (CMS) Center for Program Integrity, about where most fraud occurs geographically or whether more fraud occurs in Medicare or private insurance.
During his opening statement (PDF), Alexander highlighted the success of national fraud takedowns, highlighting the agency's reliance on data to move beyond a "pay-and-chase" approach to enforcement.
RELATED: HHS recovered $2.6B from healthcare fraud in 2017, down 21% from the previous year
Rep. Carlos Curbelo, R-Fla., said he considers fraud a “personal issue.” South Florida, including his district, has long been known as the “Medicare fraud capital” of America, he said, holding up a June 28 article from the Miami Herald.
“Our community does not want to be known as a place where Medicare fraud is prevalent,” Curbelo said. “We look forward to working with all of you to root out this horrible situation in our country.”