government

Medicare anti-fraud bills backed by AARP

Lawmakers want officials to increase fraud penalties, perform additional screenings of physicians and suppliers, and analyze claims more quickly to detect suspicious billing.

By Chris Silva — Posted Aug. 18, 2010

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AARP has announced its endorsement of legislation pending in Congress that it believes are strong measures to combat Medicare fraud.

The Medicare Fraud Enforcement and Prevention Act is "a tough new bipartisan bill" that will help crack down on Medicare fraud, protecting seniors and taxpayers alike, said the two lawmakers who introduced it in April, Reps. Ileana Ros-Lehtinen (R, Fla.) and Ron Klein (D, Fla.). Kirsten Gillibrand (D, N.Y.) introduced companion legislation in the Senate. The bills would give law enforcement officials quicker access to Medicare claims data, allowing them to act swiftly in the event of suspicious billing activity, AARP said in late July.

The Fighting Fraud with Innovative Technology Act, sponsored by Rep. Peter Roskam (R, Ill.), would overhaul the review of Medicare claims by applying the same technology used by credit card companies to minimize fraudulent transactions.

AARP said its senior members deserve strong enforcement from Congress to ensure that their premiums and tax dollars are protected from fraud.

"These are important components in a more holistic effort to not only fight the fraud that is occurring, but also ensure fraud is stopped before it happens through strong preventive measures," said Nancy LeaMond, AARP's executive vice president. "AARP will pursue all necessary remedies to effectively fight fraud for which we all pay, and we urge Congress to make Medicare anti-fraud efforts a priority and pass these bills."

Ros-Lehtinen said an estimated $60 billion a year is stolen from Medicare, adding that reform measures such as the ones supported by AARP are necessary to gain the trust of the nation's seniors.

"South Florida is known as the epicenter of Medicare fraud, which is why Ron Klein and I are working together for a solution to this intolerable problem," she said.

Their bill would update two key provisions in the criminal code to fight Medicare fraud -- the false statements and anti-kickback statutes in the Social Security Act. Penalties for those violations have not been updated since 1977, and criminal conspiracies against Medicare have increased dramatically since then, the lawmakers said.

The act would double criminal penalties for false claims and violations of the anti-kickback statute from five years to 10 years and increase fines from $25,000 to $50,000. It also would create a type of offense for illegally distributing a Medicare or Medicaid beneficiary's ID, setting a maximum penalty of three years in prison and a fine. In addition, fingerprinting, random site visits and criminal background checks for suppliers and physicians considered to be high risk would be implemented to ensure that they're running legitimate businesses.

Roskam's measure, which he introduced June 16, seeks to leverage the predictive modeling technology that major credit card companies use to process more than $11 trillion in transactions a year while minimizing fraud. "Looking to the financial services industry tells us that there is a way to reduce fraud and ensure that taxpayer dollars are being used to provide health care to those who need it, not to line the pockets of greedy scam artists," he said.

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