Lawmakers Publish Recommendations to Combat Medicare, Medicaid Fraud

Six lawmakers from both sides of the aisle have released a report outlining recommendations from more than 160 stakeholders on methods to combat fraud and abuse in the Medicare and Medicaid programs.

Last May, the bipartisan group of lawmakers asked members of the healthcare community to submit white papers with their best ideas to fight Medicare and Medicaid fraud. Approximately 2,000 pages of input were received from healthcare professionals, corporate stakeholders and associations.

Some recommendations highlighted in the report include:
• Increasing federal funding for state Medicaid anti-fraud activities.
• Clarifying the circumstances in which use of care and the setting for care is appropriate, such as when it is appropriate to use inpatient care versus outpatient.
• Ensuring that provider enrollment policies are consistent and utilized effectively.
• Making process changes to how various CMS audit contractors operate to ensure they are doing so efficiently and effectively.
• Balancing incentives for Medicare contractors to identify overpayments with penalties for contractors whose findings are overturned on appeal through the CMS administrative process.
• Creating an advisory panel to provide clinical input as a component of contractor oversight.

Those lawmakers involved in the fight against Medicare and Medicaid fraud are current and former members the Senate Finance Committee: Orrin Hatch (R-Utah), Max Baucus (D-Mont.), Tom Coburn (R-Okla.), Ron Wyden (D-Ore.), Chuck Grassley (R-Iowa) and Tom Carper (D-Del.).

More Articles on Medicare and Medicaid Fraud:

12 of the Largest False Claims Settlements in 2012
DOJ Breaks Record for Healthcare Recoveries Under False Claims Act
OIG Expects $6.9B in Healthcare Fraud Recoveries

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