Continuing her efforts to root out waste, fraud and abuse in federal programs, U.S. Senator Kelly Ayotte (R-NH) is cosponsoring bipartisan legislation aimed at preventing billions of dollars in improper Medicare and Medicaid payments. The Fighting Fraud and Abuse to Save Taxpayer Dollars (FAST) Act (S. 1251), introduced by Senators Tom Coburn (R-OK) and Tom Carper (D-DE), would implement much-needed reforms to reduce improper payments and strengthen anti-fraud measures. An April 2012 Government Accountability Office (GAO) report identified $28.8 billion in improper Medicare Fee-for-Service payments and $21.9 billion in improper Medicaid payments.
"Billions in improper Medicare and Medicaid payments highlight the urgent need for stronger oversight and accountability," said Senator Ayotte. "Every dollar wasted through fraud and abuse threatens the long-term solvency of these programs. This legislation would implement common sense anti-fraud reforms, taking important steps to protect taxpayers."
FAST ACT HIGHLIGHTS:
The FAST Act proposes to:
Prevent Medicare Thieves from Pretending to be Doctors: makes it more difficult for fraudsters to misuse Medicare provider billing information, such as physician identification numbers used to prescribe drugs.
Prevent Criminals and Drug Addicts from "Pharmacy Shopping:" creates incentives for all states to establish prescription drug monitoring programs that flag incidents where criminals try to fill multiple prescriptions in a single day.
Phase-Out the Medicare "Pay and Chase" Policy: Medicare currently practices what is often called "pay and chase," in which a Medicare provider is paid, and then chased down later for a refund once an error or fraud is detected. Too often the improper payment is never recouped. The FAST Act requires that the Centers for Medicare and Medicaid Services perform prepayment checks of Medicare reimbursements across the nation, before payments are made. For example,
Medicare rules require that emergency ambulance rides have to match an emergency room visit in order to receive reimbursement. But these cross-checks to prevent ambulance rides to nowhere are only happening weeks or months after payment. By preventing questionable payments being made in the first place, we can better ensure legitimate Medicare reimbursement.
Encourage Seniors to Report Possible Fraud And Abuse in Medicare: improves outreach to Medicare beneficiaries, the front line in helping combat waste and fraud.
Implement Reforms to Help Prevent Overpayments When Errors are Identified: requires the Centers for Medicare and Medicaid Services to closely track overpayments, and implement solutions that will close loopholes, stop patterns of double billing and other steps.
Improve Data-Sharing and Deploy Smart Technologies to Better Identify Fraud: improves current fraud tracking systems and coordination and data sharing between federal and state entities
Incentivize Medicare Contractors to Avoid Overpayments and Errors: establishes improved payment accuracy and other benchmarks for bill paying companies under contract with Medicare. By incentivizing the contractors to avoid errors and overpayments, the improper payment rate should shrink.
Increase Penalties for Fraudulent Use of Patient or Provider Information: for the first time, outlaws the fraudulent purchase, sale, or distribution of Medicare beneficiary and provider identification numbers.