STEARNS EARLIER HELD HEARING ON MEDICARE AND MEDCAID FRAUD TO ASSESS THE PROBLEM

WASHINGTON, NOV. 18, 2011 – “As Chairman of the House Energy and Commerce Committee’s Subcommittee on Oversight and Investigations, I held a hearing on fraud in the Medicare and Medicaid programs, yet Administration officials were unable to even venture a guess on the cost of this fraud,” said Rep. Cliff Stearns (R-FL).  “However, other studies put the losses in waste and fraud at $60 billion to $90 billion a year.  The hearing also yielded specific recommendations to reduce fraud, and I developed this bill based upon those and other recommendations to strengthen Medicare and Medicaid without increasing the programs’ costs.”

Stearns today introduced H.R. 3474, the Promoting Responsibility in Medical Expenditures (PRIME) Act.  Explained Stearns, “In reducing fraud and abuse, my measure would increase criminal and civil penalties for those who defraud the system and require the Centers for Medicare and Medicaid Services (CMS) to measure how much fraud occurs in the Medicare and Medicaid programs.  It also promotes the use by CMS of predictive analytics such as those used by credit card companies to deter fraud, and would standardize some Medicare submissions forms and require validation of prescriber numbers, beneficiary numbers, and provider numbers before a payment is made to stop fraud before it occurs rather than chasing criminals after a fraudulent payment is made.”

In addition, H.R. 3474 would require a Government Accountability Office study on disclosure of Medicare claims data. Just about every part of the government discloses their spending including the Department of Defense. However, Medicare does not disclose its expenditures.  A transparent government should provide this information, but it should be done in a responsible manner that protects the privacy of providers and beneficiaries.