Health Care Reform Bill Continues to Focus on Fraud and Abuse
The Facts
On July 14, 2009, the chairmen of three House Committees with jurisdiction over health policy introduced the America’s Affordable Health Choices Act of 2009. The fraud and abuse provisions from the first House bill remain with some changes to strengthen penalties or make technical corrections. The bill also includes several new provisions and provides for $100 million additional annual funding of the Health Care Fraud and Abuse Control Fund.
Changes or technical corrections to existing provisions include the following:
- Authorization for the Secretary to disenroll certain providers of services or suppliers for failing to establish a compliance program with required core elements
- Clarification that a provider's repayment of an overpayment does not limit the provider's potential exposure to other governmental actions such as interest, fines, civil or criminal sanctions it if is later determined that the overpayment was related to fraud by the provider or supplier or by provider or suppliers employees or agents
- Expansion of the requirement for physician face-to-face encounters with patients prior to certifying eligibility for home health services to also mandate this requirement prior to ordering durable medical equipment or any other service if the Secretary determines it would reduce the risk of fraud waste and abuse
New provisions include the following:
- Language addressing the period and effect of the Office of Inspector General exclusion authority
- A requirement for billing agents and clearinghouses to register with the Secretary
- Amendments to conform the Civil Monetary Penalties law to the recent False Claims Act amendments
What’s at Stake?
The health care reform fraud and abuse provisions have a wide reach and touch on nearly every aspect of providing health care—from enrolling as a provider to payment for services. Strict enforcement and penalty provisions will raise the compliance bar to new heights.
Steps to Consider
Consider how current compliance programs, policies and procedures, including those for repaying overpayments, will need to be modified to manage proactively the government’s increased focus on fraud and abuse.
