The Senate Special Committee on Aging held a hearing in early May to discuss Medicare and Medicaid waste, fraud, and abuse.
“While home medical equipment (HME) fraud only constitutes a small fraction of overall Medicare fraud, we firmly believe that any abuse of the Medicare system is a disgraceful waste of taxpayers’ dollars and represents theft of resources needed by patients, seniors and individuals with disabilities,” the American Association of Homecare said in a letter to the committee.
Daniel R. Levinson, Inspector General at the Health and Human Services Department, testified that Congress should safeguard against Medicare fraud by focusing on enrollment. He also noted excessive reimbursement for HME items.
“Getting prices aligned with the market would make DME fraud less attractive,” he said.
“OIG has identified reimbursement rates for certain items and services that are too high, resulting in waste and opportunities for fraud and abuse,” Levinson said in his written testimony. “We determined that if home oxygen payments were limited to 13 months rather than the current 36 months, Medicare and its beneficiaries would save $3.2 billion over 5 years.”
“Prosecutions are not the answer,” said R. Alexander Acosta, U.S. Attorney for the Southern District of Florida at the U.S. Department of Justice. “The best way to prevent fraud is by implementing systematic changes at CMS.”
In another effort to fight fraud, U.S. Attorney General Eric Holder and HHS Secretary Kathleen Sebelius launched the Health Care Fraud Prevention and Enforcement Action Team (HEAT) on May 20. The interagency group will include senior officials from the Department of Justice and HHS who will build upon and strengthen existing programs to combat fraud and invest new resources and technology to prevent fraud, waste and abuse before it happens.
Other efforts include the expansion of joint DOJ-HHS Medicare Fraud Strike Force teams that have been fighting fraud in south Florida and Los Angeles. Established in 2007, the teams have used a “data-driven” approach to identify unexplainable billing patterns and investigating these providers for possible fraudulent activity.
New teams will be formed to target Detroit and Houston.
“Fraud is happening in communities across the country right now and we need the American people to blow the whistle on thieves and criminals who are stealing from all of us,” said Sebelius.
More than $241 million has been recovered in south Florida and Los Angeles through the work of the two strike forces.
On May 6, Sens. Mel Martinez (R-Fla.) and John Cornyn (R-Tex.) introduced the Seniors and Taxpayers Obligation Protection (STOP) Act. It is designed to reduce waste and fraud by creating additional prevention and detection systems for the Medicare program.