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Biggert Introduces Medicare Fraud Prevention Bill

Location: Washington, DC

Biggert Introduces Medicare Fraud Prevention Bill

Today U.S. Representative Judy Biggert (R-IL-13) introduced legislation to crack down on the waste, fraud and abuse in the Medicare system that is costing taxpayers as much as $54.5 million a day.

Biggert's bill, H.R. 5962 or the Medicare Fraud, Prevention and Enforcement Act, is designed to prevent waste, fraud and abuse by strengthening the Medicare enrollment process, expanding certain standards of participation, and reducing erroneous payments. The bill also gives law enforcement agencies additional tools to pursue health care swindlers.

The legislation includes the following provisions:

• Amends title 18 of the Social Security Act to reduce Medicare's susceptibility to fraudulent billing and to provide the Inspector General (OIG) of the Department of Health and Human Services with additional tools to fight waste, fraud and abuse.

• Authorizes the Office of the Secretary of Human and Health Services (HHS) to conduct site inspections and background checks of suppliers, health centers and other provider groups that apply for provider numbers to provide services for Medicare recipients.

• Allows HHS to refuse to issue a provider number to individuals or organizations that have a history of bankruptcy, civil judgments and felony convictions. The HHS would, in turn, report the information about the applicable provider - and HHS' refusal to issue a provider number - as a red flag to the health integrity protection database (HIPDB). The HIPDB is a database that identifies and flags healthcare practitioners, providers and suppliers involved in fraud and abuse.

"Over the past few years, Medicare fraud has skyrocketed, depriving millions of seniors the quality care they deserve and bilking taxpayers out of billions of dollars," said Biggert. "Medicare is already facing the pressure of baby boomer retirements, and we must do everything we can to target the waste, fraud and abuse in the system."

According to the HHS' Inspector General, waste, fraud, abuse and other improper payments drained as much as $19.9 billion from the Medicare Trust Fund in 2004 alone. Among the fraudulent claims identified in the past are:

• Two doctors who submitted in excess of $690,000 in fraudulent Medicare claims listed nothing more than a Brooklyn, New York, laundromat as their office location.

• In Florida, over $6 million in Medicare funds were sent to medical equipment companies that provided no services whatsoever.

• One of the Florida companies listed a fictitious address that would have placed the business in the middle of a runway at the Miami International Airport.

"Phony addresses and bogus providers add up to Medicare fraud and taxpayers being swindled out of billions of dollars," said Biggert. "There is no easy solution to ending Medicare fraud. But the Medicare Fraud, Prevention and Enforcement Act will make it more difficult for unscrupulous individuals to enter and take advantage of the Medicare system."

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