Federal officials are cracking down hard on healthcare fraud, waste and abuse thanks to strong backing from the Obama administration, lawmakers on both sides of the aisle and specific provisions in the Patient Protection and Affordable Care Act (ACA).
ACA authorizes the Department of Health and Human Services' Office of Inspector General (OIG) to "assume a range of expanded oversight responsibilities" to uncover and prosecute healthcare fraud, explained Lewis Morris, OIG chief counsel, at a recent House Ways and Means subcommittee hearing.
ACA contains several provisions that strengthen OIG's ability to combat abuses of federal and private healthcare payment systems, including:
More stringent screening procedures for new applicants seeking Medicare billing approval.
Compliance training programs to encourage healthcare providers to adopt internal controls against fraud. Eventually, the HHS secretary may require providers, as a condition of enrollment, to adopt compliance programs that "meet a core set of requirements."
Requirement that providers report and repay any CMS overpayment within 60 days or face liability under the False Claims Act.
Increased transparency and reporting requirements to disclose financial relationships between physicians and healthcare companies.
Swifter and harsher penalties on providers that commit healthcare fraud.
Increased funding for federal anti-fraud audits, investigations and enforcement.
Mr. Morris told lawmakers that the "Medicare program is increasingly infiltrated by violent criminals," but that "major corporations such as pharmaceutical and medical device manufacturers and institutions such as hospitals and nursing facilities have also committed fraud, sometimes on a grand scale." For example, he pointed to an OIG investigation that found that 63% of facet joint injections for pain management allowed by Medicare in 2006 "did not meet program requirements, resulting in $96 million in improper payments."
The full text of Mr. Morris' prepared testimony is available here.
Irene Tsikitas
