Bill would let Medicare delay payments when fraud, waste suspected

Right now, Medicare is in the business of paying claims whether it likes them or not. In fact, as current federal law is written, CMS must pay Medicare claims promptly even if officials think fraud or abuse may be involved.

Sen. Chuck Grassley (D-Iowa), however, isn't happy with this state of affairs. He's floating new legislation that would give HHS the authority to extend the time period in which Medicare claims must be paid if the office suspects any form of funny business, even needless procedures or tests.

To postpone payments, HHS would only need to decide that fraud, waste or abuse is likely. HHS would be required to review the claims more closely during this additional period, which could stretch into as much as a year in some cases, or even indefinitely in others.

Grassley's bill would also demand that the HHS Office of the Inspector General recommend yearly (or more often) provider or supplier categories that seem to need more scrutiny before payments are released.

It's hard to imagine that this bill would sail through Congress, given the intense activity around the health reform bills and the controversial nature of holding back claims due to alleged "waste." That being said, I'd definitely keep an eye on this topic. Congress is going to be flailing around trying to reduce wasteful spending, and this won't be the last attempt to write some standard into law.

To get more perspective on this proposal:
- read this HFMA News piece

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