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May 19, 2013

Senators Seek Input from Health Care Community on Fraud and Abuse Prevention

May 2, 2012 six Senators from the Senate Finance Committee released an open letter to the health care community requesting a “fresh perspective” regarding fraud and abuse in Medicare and Medicaid. The letter requests input from a variety of stakeholders in the health care community, including providers, payers, health plans, contractors, non-profit entities, consumers, data analytics entities, governmental partners and patients. With stakeholder input, the Senators hope to “identify innovative solutions that will provide taxpayers with a better return on the investments being made to combat the overpayments in these federal health care programs.”

The letter solicits input from stakeholders regarding “solutions and suggestions for how to better prevent and combat the multi-billion dollar problem of waste, fraud and abuse in the Medicare and Medicaid programs.” Specifically, the Senators request submission of white papers discussing what areas stakeholders see for “improvement in current program integrity efforts” as well as additional “solutions that may have been overlooked or underutilized.”

White papers should focus on the following issues:

  • Program integrity reforms to protect beneficiaries and prevent fraud and abuse;
  • Payment integrity reforms to ensure accuracy, efficiency and value; and
  • Fraud and abuse enforcement reforms to ensure tougher penalties.

The Senate Finance Committee expects to assemble a document outlining key proposals later in 2012. The letter was signed by a group of six members of the Senate Finance Committee: Chairman Max Bacus (D-Mont.), Ranking Member Orrin Hatch (R-Utah), Ron Wyden (D-Ore.), Tom Coburn (R-Okla.), Tom Carper (D-Del.) and Chuck Grassley (R-Iowa).

Stakeholders should submit white papers in PDF or Microsoft Word format to ProgramIntegrityWhitePapers@finance.senate.gov by June 29, 2012. The Senate Finance Committee’s press release on the open letter is available here.

©2013 von Briesen & Roper, s.c

About the Author

Meghan O’Connor is a member of the Health Care Practice Group. Her practice focuses on general health law including managed care and provider contracting, risk management, and regulatory compliance.

Prior to joining von Briesen, Meghan worked for the Centers for Medicare and Medicaid Services where she consulted with states regarding federal health law, regulation and policy, evaluating managed care contracts and conducting compliance reviews.

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