Senators plan to improve Medicare/Medicaid program integrity efforts

AHA News Now

Six current and former members of the Senate Finance Committee yesterday announced they will work with Congress, federal agencies and stakeholders to develop specific administrative and potential legislative actions to improve Medicare and Medicaid program integrity efforts. The announcement came as part of a report summarizing recommendations the group received from health care and other stakeholders in response to its May solicitation of innovative solutions to improve program integrity, strengthen payment reforms and enhance fraud enforcement. The report highlights several recommendations received, which include eliminating duplication and redundancy in federal and state antifraud programs; clarifying when it is appropriate to use certain care and settings; making process changes to ensure CMS audit contractors are efficient and effective; balancing incentives to identify Medicare overpayments with penalties for contractors whose findings are overturned on appeal; and creating an advisory panel to provide clinical input as part of contractor oversight. AHA submitted recommendations to the senators in June.

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