Legislation offered on Jan. 18 by U.S. Sen. Bill Cassidy (R-LA) aims to improve the fraud detection process at the Center for Medicare and Medicaid Services (CMS).
“Medicare fraud should always be fought, but with insolvency only eight years away we must be particularly careful about how we spend every dollar,” Sen. Cassidy said. “This gives CMS the tools they need to fight fraud and to save the money to actually take care of patients.”
Sen. Cassidy cosponsored the Medicare Transaction Fraud Prevention Act, S. 3630, with bill sponsor U.S. Sen. Mike Braun (R-IN) to establish a pilot program at CMS for testing the use of a predictive risk-scoring algorithm that would provide oversight of payments for durable medical equipment (DME) and clinical diagnostic laboratory tests under the Medicare program, according to the congressional record bill summary.
“An annual loss of $60 billion is unacceptable,” said Sen. Braun. “It’s time for CMS to strengthen their fraud detection process in order to stop the hemorrhaging of the Medicare trust fund.”
In certain instances, criminals obtain fraudulent Medicare reimbursements after Medicare beneficiaries are charged for unapproved diagnostic tests, wheelchairs, braces, and other DME products, according to a bill summary provided by Sen. Cassidy’s staff.
If enacted, S. 3630 would direct CMS to create a two-year pilot to oversee Medicare-covered purchasing of DME and other diagnostic testing related products. Under the program, beneficiaries would be asked to voluntarily verify certain purchases to give CMS increased access to predictive data and test proof of concept for future use, the summary says, adding that the program would help Medicare improve fraud detection without overhauling the entire process.
The legislation has been referred for consideration to the U.S. Senate Finance Committee.