In addition to proposed measures that would lower drug costs for Medicare Part D, President Barack Obama's $4 trillion budget proposal for fiscal year 2016 includes specific interventions to curb fraud, waste and abuse within Medicare and Medicaid. The measures are projected to save an estimated $3 billion over the next ten years.
Specifically, the proposed budget highlights four new initiatives to curb fraud in targeted areas:
- Requiring prior authorization for power mobility devices and advanced imaging. This prior authorization initiative could be extended to other high risk areas. Previously, federal investigators have targeted fraud schemes involving power wheelchairs.
- State-based tracking of high prescribers and utilizers of prescription drugs within Medicaid that would better identify unusual billing and prescribing patterns.
- Supporting efforts to investigate and prosecute Medicaid fraud and abuse in non-institutional healthcare settings.
- Strengthening the Federal Government's ability to identify fraud, waste and abuse through the Medicaid Integrity Program.
The budget also includes efforts to streamline state program integrity reporting requirements by consolidating redundant error rate measurement programs, which would provide more meaningful outcomes within audit programs.
FierceHealthPayer looks at ways in which the proposed budget seeks to lower drug prices by allowing the federal government to negotiate costly drugs covered in the Medicare Part D program. The initiative would also allow the Secretary of Health and Human Services to suspend coverage and payment for questionable Part D prescriptions. Last May, CMS released a final rule to more effectively screen drug prescribers, and in November, a report by the Government Accountability Office found that CMS incorporates 14 of 23 recommended practices for addressing fraud waste and abuse within Medicare Part D.
- here's the proposed budget