Monday, February 22, 2010

Whitehouse Health Reform Proposal with Some Republican Ideas

The President has unveiled the Whitehouse proposal for health reform. There are a few points where there is common ground with the Republican agenda.

Review of new Republican initiatives included in the President’s Proposal:



  • Comprehensive Sanctions Database. The President’s Proposal establishes a comprehensive Medicare and Medicaid sanctions database, overseen by the HHS Inspector General.  This database will provide a central storage location, allowing for law enforcement access to information related to past sanctions on health care providers, suppliers and related entities.

    • (Source: H.R. 3400, “Empowering Patients First Act” (Republican Study Committee bill))
  • Registration and Background Checks of Billing Agencies and Individuals. In an effort to decrease dishonest billing practices in the Medicare program, the President’s Proposal will assist in reducing the number of individuals and agencies with a history of fraudulent activities participating in Federal health care programs.  It ensures that entities that bill for Medicare on behalf of providers are in good standing.  It also strengthens the Secretary’s ability to exclude from Medicare individuals who knowingly submit false or fraudulent claims.

    • (Source:  H.R. 3970, “Medical Rights & Reform Act”)
  • Expanded Access to the Healthcare Integrity and Protection Data Bank.  Increasing access to the health care integrity data bank will improve coordination and information sharing in anti-fraud efforts. The President’s Proposal broadens access to the data bank to quality control and peer review organizations and private plans that are involved in furnishing items or services reimbursed by Federal health care program.  It includes criminal penalties for misuse.

    • (Source:  H.R. 3970, “Medical Rights & Reform Act”)
  • Liability of Medicare Administrative Contractors for Claims Submitted by Excluded Providers. In attacking fraud, it is critical to ensure the contractors that are paying claims are doing their utmost to ensure excluded providers do not receive Medicare payments. Therefore, the President’s Proposal provision holds Medicare Administrative Contractors accountable for Federal payment for individuals or entities excluded from the Federal programs or items or services for which payment is denied.

    • (Source:  H.R. 3970, “Medical Rights & Reform Act”)
  • Community Mental Health Centers. The President’s Proposal ensures that individuals have access to comprehensive mental health services in the community setting, but strengthens standards for facilities that seek reimbursement as community mental health centers by ensuring these facilities are not taking advantage of Medicare patients or the taxpayers.

    • (Source:  H.R. 3970, “Medical Rights & Reform Act”)
  • Limiting Debt Discharge in Bankruptcies of Fraudulent Health Care Providers or Suppliers. The President’s Proposal will assist in recovering overpayments made to providers and suppliers and return such funds to the Medicare Trust Fund.  It prevents fraudulent health care providers from discharging through bankruptcy amounts due to the Secretary from overpayments.

    • (Source:  H.R. 3970, “Medical Rights & Reform Act”)
  • Use of Technology for Real-Time Data Review. The President’s Proposal speeds access to claims data to identify potentially fraudulent payments more quickly.  It establishes a system for using technology to provide real-time data analysis of claim and payments under public programs to identify and stop waste, fraud and abuse.

    • (Source:  Roskam Amendment offered in House Ways & Means Committee markup)
  • Illegal Distribution of a Medicare or Medicaid Beneficiary Identification or Billing Privileges.  Fraudulent billing to Medicare and Medicaid programs costs taxpayers millions of dollars each year.  Individuals looking to gain access to a beneficiary’s personal information approach Medicare and Medicaid beneficiaries with false incentives.  Many beneficiaries unwittingly give over this personal information without ever receiving promised services.   The President’s Proposal adds strong sanctions, including jail time, for individuals who purchase, sell or distribute Medicare beneficiary identification numbers or billing privileges under Medicare or Medicaid – if done knowingly, intentionally, and with intent to defraud.

    • (Source:  H.R. 3970, “Medical Rights & Reform Act”)
  • Study of Universal Product Numbers Claims Forms for Selected Items and Services Under the Medicare Program. The President’s Proposal requires HHS to study and issue a report to Congress that examines the costs and benefits of assigning universal product numbers (UPNs) to selected items and services reimbursed under Medicare. The report must examine whether UPNs could help improve the efficient operation of Medicare and its ability to detect fraud and abuse.
    • (Source:  H.R. 3970, “Medical Rights & Reform Act”, Roskam Amendment offered in House Ways & Means Committee markup)