Cornyn & Martinez Team Up To Stop Fraud in Medicare & Medicaid

Press Release

Cornyn & Martinez Team Up To Stop Fraud in Medicare & Medicaid

Effort seeks to recapture estimated $60 billion lost each year to Medicare & Medicaid scams

U.S. Senators John Cornyn (R-TX) and Mel Martinez (R-FL) today introduced two efforts targeted at detecting and preventing Medicare and Medicaid waste, fraud, and abuse. The Seniors and Taxpayers Obligation Protection or "STOP" Act 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 will require transparency in billing for services and medical equipment. These acts give the Centers for Medicare & Medicaid Services (CMS), the Department of Health and Human Services (HHS), and the Social Security Administration (SSA) the tools and authority to prevent fraud before it starts and detect waste and abuse early. The STOP Act is co-sponsored by Senators Lamar Alexander (R-TN), Susan Collins (R-ME), Bill Nelson (D-FL), and David Vitter (R-LA).

"Medicare fraud and abuse not only wastes an estimated $60 billion a year of taxpayer dollars, it hurts legitimate providers and Medicare recipients," said Sen. Cornyn. "Especially in today's economy, Congress should take every opportunity to ensure that taxpayers' hard-earned money is protected and not wasted. This legislation will better detect and prevent abuse of the system to stop Medicare fraud before it starts. I urge my colleagues to support this important measure so we can strengthen protections for taxpayers and those who depend on Medicare."

"Entitlement program fraud is out of control. Each year, criminal fraud in Medicare and Medicaid diverts billions away from programs that care for our nation's 43-million seniors and disabled persons," said Martinez, Ranking Member of the Senate's Special Committee on Aging. "Especially in this time of limited resources and efforts to find savings, starting with the largest fraud makes sense. We need a proactive approach to tackle this problem and that begins with efforts to bring transparency to the system and commonsense efforts to detect and prevent fraud."

"This legislation takes a big step in preventing Medicare fraud and abuse, which costs taxpayers up to $60 billion each year, and it will help ensure that Medicare spending is actually reaching Medicare patients," said Alexander, a member of the Senate Committee on Health, Education, Labor and Pensions. "I will continue working to make sure Medicare recipients' medical needs are met as the Senate debates health care."

"While the vast majority of health care providers are honest and caring professionals, it is simply unacceptable that there still are people who are willing to scam the system and take advantage of some of our nation's most vulnerable citizens," said Senator Collins. "This legislation would establish a system that would help prevent health care fraud that is costing American taxpayers more than $60 billion each year."

"If we are to be effective in combating Medicare fraud, we need to make sure the government has all the tools it needs," said U.S. Sen. Bill Nelson.

"Americans expect better fiscal management from their government, and this legislation helps stop the loss and waste of our already-strained Medicare funds by also providing fraud protection and prevention mechanisms for our seniors," said Sen. David Vitter.

In particular, 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, thus reducing 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.

"These steps will help protect seniors and doctors from identity theft, keep criminals from becoming Medicare providers, and strengthen data mining and matching to catch criminals currently in Medicare in real time," said Martinez.

The MAT Act will 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. By disclosing Medicaid payment data, this amendment will protect American taxpayers by reducing waste, fraud, and abuse.

Martinez notes the MAT Act will allow the proper authorities to prosecute fraud cases without compromising the identity of Medicaid beneficiaries. To ensure compliance, the bill imposes a penalty of $25,000 per day for any period in which the Secretary of HHS has found a state to have not fully and properly complied with the requirements for data collection associated with the Medicaid Statistical Information System.

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