Senate Finance Hints at Program Integrity Changes for CMS

After soliciting stakeholders’ input a new report from committee summarizes their concerns.

While everyone agrees that preventing waste, fraud, and abuse in Medicare and Medicaid is a top priority, questions abound about how to achieve that goal. The ultimate question is how should the federal government preserve integrity in healthcare programs as well as a healthy marketplace and access to quality care at the same time?

Last year, the Senate Finance Committee invited stakeholders to submit whitepapers with recommendations about how to improve program integrity in Medicare and Medicaid.  

Now, a bipartisan report, “Senate Finance Program Integrity White Papers: Summary and Overview of Recommendations,” released last week by five members of the Finance Committee summarized concerns raised by the healthcare industry, patient advocates, and other stakeholder groups about how to improve efforts to prevent waste, fraud, and abuse.

The key recommendations that emerged from the 146 stakeholder groups focused on:

  • Improper payments,
  • Audit burdens,
  • Enforcement issues,
  • Data management, and
  • Protecting beneficiaries.

The stakeholders included hospital and physician associations, insurers, durable medical equipment providers, and data management contractors. The report merely summarizes varied concerns from different types of interested parties, an April 24 statement from the Committee promises review of the recommendations to determine whether legislative action is needed.

Also, the Senate Finance Committee asked the Government Accountability Office to examine the federal auditing process for Medicare and Medicaid providers — or, audit the auditors.  Kim Brandt, who is chief oversight counsel to Sen. Orrin Hatch, said last week that the first of the GAO reports on audits is expected to be released within the next few months.

Various healthcare provider groups including the American Association for Homecare and the National Association for Home Care and Hospice have proposed stronger anti-fraud and abuse measures.  

About the Author

Michael Reinemer is the principal of public affairs and marketing communications consulting firm Reinemer Communications, which is based in Annandale, Va. He can be reached via email at michaelreinemer@hotmail.com. To learn more, visit www.reinemercommunications.com.

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