Senate issues anti-fraud recommendations

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The Senate Finance Committee and federal agencies will be working on legislation to combat Medicare and Medicaid fraud, waste and abuse, the finance committee said Thursday. Among the items up for discussion are appropriate care settings, redundant audits and increased funds for state anti-fraud activities.

Touted as a bipartisan committee, the report signals an aggressive campaign against Medicare and Medicaid fraud and waste.

Last May, the committee invited comments and received 2,000 pages of input from health systems, healthcare associations, insurers and suppliers, among other stakeholders.

"Recommendations from the experts in the field are key toward shutting down sources of waste, fraud, abuse and inefficiency," Chuck Grassley (R-Iowa) said. "We need all hands on deck to protect every dollar in these programs."

Among recommendations from the field were suggestions to eliminate duplicative federal and state efforts and to change how CMS auditors operate. Recent reports from the Government Accountability Office and the Office of Inspector General indicate integrity efforts are failing and even losing money.

The Senate Finance Committee also acknowledged the key issue of appropriate care setting--one of the biggest sore spots for providers who are subject to audits and recoupments for observation stays that exceed CMS guidelines.

The American Hospital Association last June asked for better guidance from CMS about what care is appropriate in what setting, while asking CMS to acknowledge the role of the treating physician in hospital admissions.

The Senate also is considering other recommendations, including creating an advisory panel to provide clinical input as a component of contractor oversight and penalizing contractors whose findings are overturned on appeal.

For more information:
- here's the Senate Finance announcement and report (.pdf)
- see the AHA recommendations (.pdf)

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