New bipartisan proposal targets ‘one of the most egregious’ kinds of fraud
A new bipartisan congressional proposal is expected to crack down on Medicaid and Medicare fraud by utilizing Social Security Administration death records. The proposed legislation, known as the Medicare and Medicaid Fraud Prevention Act, will require state governments to cross-reference the Social Security Death Master Files to verify if physicians participating in government programs for seniors and low-income individuals are still active. This verification process aims to prevent fraudulent use of a doctor’s National Provider Identifier by bad actors.
Rep. Gabe Evans, R-Colo., who is co-sponsoring the bill with Rep. Scott Peters, D-Calif., emphasized the importance of safeguarding Medicaid and Medicare from fraud to protect those who truly rely on these programs for healthcare. The bill builds upon similar legislation introduced last year by former Rep. Mike Garcia and Peters, which passed the House but stalled in the Senate Finance Committee.
As scrutiny on the Medicaid and Medicare programs intensifies at both the state and federal levels, the need for measures to combat fraud becomes more pressing. In Colorado, a staggering $7.3 million was disbursed to insurance companies for deceased Medicaid recipients, highlighting the urgency of addressing fraudulent activities. Similarly, California is grappling with a $9.5 billion cost overrun for its Medicaid affiliate, Medi-Cal, significantly surpassing the initial budget estimate of $6 billion.
The introduction of the Medicare and Medicaid Fraud Prevention Act coincides with reports of substantial improper payments in government healthcare programs. In fiscal year 2024, Medicare saw $54.3 billion in improper payments, while Medicaid recorded $31.1 billion. The Department of Government Efficiency has also initiated investigations into government healthcare spending to identify and rectify inefficiencies.
While California Governor Gavin Newsom attributed part of the cost escalation to the inclusion of illegal immigrants in the program, he acknowledged that the state shares similar challenges with other states in managing healthcare program costs. The proposed legislation underscores the bipartisan commitment to enhancing oversight and accountability in Medicaid and Medicare to ensure the programs serve their intended beneficiaries effectively.
In conclusion, the Medicare and Medicaid Fraud Prevention Act represents a crucial step towards combating fraud and safeguarding the integrity of government healthcare programs. By leveraging Social Security Administration death records to verify physician participation, the legislation aims to prevent fraudulent activities and protect the interests of individuals reliant on Medicaid and Medicare for essential healthcare services.
