Today, U.S. Representatives Ted Deutch (FL-21) and Peter Roskam (IL-6) introduced the Stop Schemes and Crimes Against Medicare and Seniors Act (Stop SCAMS Act) of 2014. The bipartisan bill seeks to prevent Medicare fraud by requiring the Centers for Medicare and Medicaid Services (CMS) to verify that a provider enrolling in the program does not have a record of defrauding Medicare in a previous practice.
Additionally, the Stop SCAMS Act would encourage private sector insurance companies to increase communication with each other and with Medicare about potentially fraudulent providers.
"In South Florida and across the country, investigators uncover elaborate Medicare fraud schemes every year that cheat taxpayers out of billions of dollars and undermine the integrity of a system that 54 million seniors and disabled Americans rely on for quality care," said Congressman Deutch. "As historic numbers of Americans approach retirement and enroll in the Medicare system, bolstering our ability to stop fraud before it happens has never been more important. The Stop SCAMS Act will keep providers with a known history of fraud out of the Medicare system for good, and I look forward to working with Congressman Roskam to bring this commonsense, bipartisan bill to the House floor as soon as possible."
"Taking common-sense measures to prevent Medicare fraud on the front-end makes all the sense in the world," said Congressman Roskam. "Each year, Medicare and Medicaid lose as much as $60 billion to waste, fraud, and abuse. In many cases, CMS has both the resources and capability to prevent fraudsters from fleecing the programs that so many of our nation's seniors rely upon--it is our obligation as lawmakers to force these simple fixes and pressure both the agencies and the private sector to step up to preserve and protect Medicare."
The Stop SCAMS Act also enjoys bipartisan support in the U.S. Senate, with Senators Bill Nelson (D-FL) and Susan Collins (R-MA) leading this effort to keep known fraudsters out of the Medicare system. Several organizations have endorsed the legislation, including the National Health Care Anti-Fraud Association, Humana, Blue Cross Blue Shield Association, America's Health Insurance Plans, the Coalition Against Insurance Fraud, and the National Insurance Crime Bureau. A brief summary of the bill is available below.
The Stop SCAMS Act
The Stop SCAMS Act of 2014 helps safeguard taxpayer dollars and reduce fraudulent payments by:
PARTNERING WITH THE PRIVATE SECTOR TO REDUCE MEDICARE FRAUD
The legislation encourages private insurers to share information about potentially fraudulent providers with Medicare and each other to prevent health care fraud through the Healthcare Fraud Prevention Partnership.
REQUIRING INDEPENDENT VERIFICATION OF PROVIDER OWNERSHIP INTERESTS
Under Medicare currently, providers who previously had an ownership interest in an organization that defrauded the Medicare program could potentially get back into the program by using a different name and failing to disclose their interest in the previous organization. The bill would require Medicare to verify provider ownership interests using other databases, including information that will be obtained under the Physician Payments Sunshine Act.
TESTING MEDICAL CODES BEFORE IMPLEMENTATION
Requires full end-to-end testing of new code sets used by doctors and other health care providers for procedures, diagnoses, and drugs before implementation. New billing code sets are important because they allow healthcare providers and Medicare to better coordinate patient care across providers, to better capture quality measurements, and to better analyze data for use in the prevention of fraud, waste, and abuse. Improved procedures for using new billing codes will ensure greater accuracy in reimbursement for medical services and help in the detection of errant claims and billing behavior.
HARNESSING EXISTING RESOURCES TO BETTER TARGET FRAUD PREVENTION EFFORTS
Allow the Medicare Payment Advisory Commission to make recommendations regarding fraud prevention, and require the Medicare program to develop a strategy for reliably estimating the effectiveness of the fraud prevention system.