A new bill introduced in Congress last week aims to close a regulatory loophole that allows healthcare executives being investigated for fraud to open a new company and continue billing Medicare.
The "Fighting Medicare Fraud Act of 2016," introduced by Lois Franke (D-Fla.) and Bill Keating (D-Mass.), allows the Department of Health and Human Services Office of Inspector General (OIG) to exclude individuals "with prior interest in sanctioned entities and entities affiliated with sanctioned entities."
Currently, healthcare executives can resign during a fraud investigation and start a new company before their previous company is sanctioned. Kirk Ogrosky, an attorney with Arnold & Porter told Bloomberg BNA that the OIG has previously advocated for this level of expanded exclusionary authority.
The bill, which was referred to the Energy and Commerce and Ways and Means committees, would also increase the minimum sentencing for stealing Medicare ID numbers to 15 years and require Medicare Advantage and Medicare Part D administrators to report instances of fraud and abuse. The OIG has repeatedly recommended that Part D sponsors report fraud and abuse to the Centers for Medicare & Medicaid Services.
"This common-sense legislation stops the cycle of deceit amongst the worst actors--toughening the consequences felt by those who illegally exploit our elderly population while strengthening the Medicare system in the process," Keating said in an announcement.
Exclusion cases were trending up toward the end of last year thanks to a new OIG litigation team devoted to civil monetary penalties and exclusion cases. Last month, the OIG released updates to its exclusion guidance, emphasizing the importance of self-reporting.
New OIG litigation team focuses on civil money penalty and exclusion cases
OIG releases updated exclusion guidance
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Civil monetary penalties, exclusion cases on the rise
Requiring Part D plan sponsors to report fraud activity would fix one of the program's many gaps