Politico Pro
January 31, 2013

Senators compile ideas for cutting fraud

A bipartisan group of senators released a slew of ideas Thursday for slicing Medicare and Medicaid waste, fraud and abuse that they’ve been gathering over the past nine months.

Among their recommendations: eliminate duplicative federal and state anti-fraud programs, make enrollment policies consistent and clarify when inpatient versus outpatient services are appropriate.

More than 160 providers, insurers, government contractors, trade associations and think tanks weighed in after the group of Senate Finance Committee members, led by Chairman Max Baucus of Montana and ranking member Orrin Hatch, asked a variety of health care players to weigh in last May on the entitlement programs.

The biggest concerns identified by stakeholders involved improper payments, auditing payments and the quality of care for beneficiaries, according to the report.

Providers and insurers were especially concerned about improving the audit process, citing the volume and complexity of payment regulations and the cost of documentation requirements.

Meanwhile, contractors were most worried about data-driven challenges, like matching medical information to the correct person and verifying the identity of patients.

With lawmakers gridlocked over how to structurally reform Medicare and Medicaid, they generally agree on the need to tackle waste and abuse. The senators said their next step is to break down the recommendations into more detailed ideas that could be turned into legislation.

“This report will be a valuable tool in our continuing efforts to combat waste, fraud and abuse in America’s health care system,” Baucus said. “We received close to 2,000 pages of input and ideas from the nation’s health care community, offering real common sense solutions.”

Sens. Tom Coburn (R-Okla.), Chuck Grassley (R-Iowa), Tom Carper (D-Del.) and Ron Wyden (D-Ore.) also worked on the report.

View article here.