Thursday, May 7, 2009

Senate Hearing on Medicare and Medicaid Fraud

On Wednesday, May 6 the Senate Special Committee on Aging convened a hearing titled Catch Me If You Can: Solutions To STOP Medicare and Medicaid Fraud From Hurting Seniors and Taxpayer. The hearing was convened by Chairman Herb Kohl (D-WI) and Senator Mel Martinez (R-FL), Ranking Member of the Senate Special Committee on Aging. The hearing featured five expert witnesses from across the country to testify about their experiences with Medicare and Medicaid fraud, as well as their ideas for solutions. The major themes of the hearing included:

· A focus on prevention; identifying fraud when claims are made, before payments occur

· Implementation of stricter penalties for fraud

· Improved screening of enrollees

· Improved screening of providers

· Increased transparency in Medicare and Medicaid spending

· Increased transparency of reimbursements received by providers

The witnesses were:

R. Alexander Acosta, US Attorney for the Southern District of Florida, US Department of Justice, Miami, FL

Daniel R. Levinson, Inspector General, US Department of Health and Human Services, Washington, DC

James Frogue, Project Director, The Center for Health Transformation, Washington, DC

Robert A. Hussar, First Deputy Inspector General, Office of the Medicaid Inspector General, State of New York, Hauppauge, NY

Stephen C. Horne, Vice President, Master Data Management and Integration Services, Dow Jones Business and Relationship Intelligence, Edgewater, NJ


Senator Martinez and John Cornyn (R-TX) have introduced two efforts targeted at detecting and preventing Medicare and Medicaid waste, fraud, and abuse. The Seniors and Taxpayers Obligation Protection or "STOP" Act (S.975) will work to reduce the estimated loss of more than $60 billion every year by creating fraud prevention and detection systems. The Medicaid Accountability through Transparency or "MAT" Act (S.974) will require transparency in billing for services and medical equipment.


The STOP Act would require the Secretary of HHS to implement changes to the current system of using Social Security Numbers as the Medicare Beneficiary Identifier (MBI) on Medicare cards, seeking to reduce fraud and identity theft among seniors. In addition, the STOP Act will also help to improve HHS's detection methods and place billing statements under increased scrutiny. Items such as durable medical equipment are notoriously known to be falsely billed at taxpayer expense - often by fake companies with nothing more than a P.O. Box.


The MAT Act seeks to reduce the prevalence of fraud in the Medicaid program by requiring HHS to publicly disclose the Medicaid payment data it already collects. Under the language, the Secretary shall establish a publicly-accessible Web site containing non-aggregated Medicaid claim payment data which has been fully de-identified according to HIPAA law. This information must be provided in a format that is easily accessible, useable and understandable to the public and shall be updated at least once per calendar quarter.

To view the full testimony:

http://aging.senate.gov/hearing_detail.cfm?id=312599&

To view the legislation, search the bill number (S.974, S. 975) on www.thomas.gov

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