OIG asks for authority over Medicare fraud

The Department of Health and Human Services' Office of the Inspector General wants more authority over Medicare fraud, including the ability to go after executives who have left the company, according to The Hill.

Currently, HHS can exclude from all federal healthcare programs any company owner or employee who knew, or should have known, about improprieties leading to a company's conviction. But, The Hill reports, there's a loophole: That individual must still be with the company. Culpable executives can resign and go to work elsewhere.

So OIG is asking Congress for a longer reach. 

"What we're trying to say to the executives is, 'This isn't just going to fall on the company,'" Lewis Morris, chief counsel for the OIG,  told The Hill. "We've got to hold the executives responsible." The culprit, he added, will "be known as the guy who was excluded from Medicare--so who's going to hire him?"

Morris also warned Congress that proposed changes in payment structure--such as bundled or global payments--would allow dishonest providers to skimp on care, the Boston Globe reports.

"Some new arrangements may require new approaches to combating fraud, waste, and abuse. Moreover, depending on their design and operation, some new arrangements may pose different risks that will need to be addressed. These risks could include, for example, stinting on care, discrimination against sicker patients, misreporting quality and performance data, and gaming of payment windows to 'double bill' for otherwise bundled services," Morris said in his testimony before  House Committee on Ways and Means, Subcommittees on Health and Oversight.

To learn more:
- check out this article in The Hill
- here's the Boston Globe article
- read Morris' prepared testimony here

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