New bipartisan bill takes aim at Medicare fraud

Two U.S. Representatives from the Ways and Means Health Subcommittee introduced a new bill focused on preventing Medicare fraud "by making a number of common sense reforms." The finalized bill is an updated version of the draft bill first released in August that targets various avenues of fraud from prescription drugs to durable medical equipment. 

The Protecting the Integrity of Medicare Act (PIMA) of 2015, co-sponsored by Ways and Means Health Subcommittee Chairman Kevin Brady (R-Texas) and ranking member Jim McDermott (D-Wash.), combines various Medicare fraud legislation previously submitted by committee members. Some highlights include:

  • Removing Social Security numbers from Medicare beneficiary cards
  • Preventing payments for incarcerated, not lawfully present and deceased individuals
  • Allowing nurse practitioners and physician assistants to document face-to-face encounters for Medicare durable medical equipment prescriptions
  • Incorporating measures to limit prescription drug fraud among Medicare Part D beneficiaries that are at-risk for prescription drug abuse
  • Requiring prior authorization for spinal manipulation after 12 chiropractic visits
  • Expanding the Centers for Medicare & Medicaid Services (CMS) program for prior authorization of "repetitive scheduled non-emergent ambulance transports" that currently exists in three states

"These are relatively modest changes," Ways and Means Committee Chairman Paul Ryan (R-Wis.) said in prepared remarks. "But put them all together, and you have a healthier, stronger Medicare program that works better for seniors, doctors, and taxpayers alike."

The bill garnered immediate support from the National Coalition on Healthcare (NCHC) as well as the Pharmaceutical Care Management Association (PCMA) and the AARP. In September, the American Hospital Association sent the subcommittee a letter of support for the draft version of PIMA, while also pointing out some unintended consequences of the legislation, FierceHealthcare previously reported.

Meanwhile, some states are looking at legislation that would address fraud, waste and abuse within Medicaid.

  • In Maryland, Attorney General Brian Frosh is pushing to expand the state's False Claims Act in order to cover fraudulent payments to private contractors.
  • In Iowa, a bill approved by the Human Resources Committee calls for a computerized asset verification system to determine Medicaid eligibility and deter fraud, according to the Sioux City Journal.
  • In Delaware, Medicaid officials were criticized by lawmakers for a delaying a $500,000 pilot program included in last year's budget that would hire an outside contractor to identify Medicaid fraud, according to The Washington Post. State officials said they are days away from hiring a contractor after missing an October deadline.

For more:
- read the final bill and the draft bill
- here's the PIMA announcement
- read the PCMA and AARP statements
- read the Maryland AG's False Claims Act announcement
- here's the Sioux City Journal article
- here's The Washington Post article

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