Medicaid Fraud Prevention Bill Receives Unanimous Support in U.S. House

Published April 14, 2016

The US House of Representatives has unanimously passed a bipartisan bill to reduce wasteful spending by prohibiting the federal government from compensating health care providers whose participation in Medicare, Medicaid, or the Children’s Health Insurance Program (CHIP) has been terminated.

House Resolution 3716, the Ensuring Removal of Terminated Providers from Medicaid and CHIP Act, could save taxpayers $28 million over the next decade, according to an analysis by the Congressional Budget Office.

The bill would require states to collect specific identifying information from health care providers participating in Medicaid or CHIP and to have a system for notifying managed care organizations when those providers have been terminated under one of the specified programs.

Representatives approved the bill 406–0 on March 2. The Senate has considered the bill twice and referred it to the Committee on Finance. The Senate has not yet voted on the legislation.

‘Just Common Sense’

Rep. Peter Welch (D-VT), a cosponsor of HR 3716, says the bill would stop federal payments to providers who submit fraudulent or otherwise inaccurate claims for reimbursement.

“This important bipartisan bill protects taxpayers from Medicaid fraud repeat offenders, who currently are able to take advantage of the system due to a lack of consistent reporting and communication between states,” Welch said.

Welch says the bill protects Medicaid beneficiaries and U.S. taxpayers from “bad actors” who abuse Medicaid.

“It’s just common sense,” Welch said. “The Senate should pass this bill without delay and send this bipartisan bill to the president.”

Obama Administration Expresses Support

The day before HR 3716 passed the House, the Executive Office of the President issued a statement of support for the bill.

Nick McGee, a spokesperson for Rep. Larry Bucshon (R-IN), the bill’s primary sponsor, says cleaning up Medicaid provider rosters will sow benefits for patients across state lines.

“HR 3716 strengthens the mechanisms to ensure providers terminated from Medicare or a state Medicaid program for reasons of fraud, integrity, or quality are also terminated from all other state Medicaid programs,” McGee said. “Bucshon’s bill improves access to care for the most vulnerable patients and saves hard-earned taxpayer dollars.”

Waste Discovered

Medicare, Medicaid, and CHIP lose tens of billions of taxpayer dollars to various inefficiencies each year, according to reports from the Government Accountability Office (GAO), the investigative arm of Congress.

“We have designated Medicare and Medicaid as high-risk programs because their size, scope, and complexity make them particularly vulnerable to fraud and abuse,” a GAO report filed January 22, 2016, stated. “Although there have been convictions for multimillion-dollar schemes that defrauded federal health care programs, the extent of the problem is unknown as there are no reliable estimates of the magnitude of fraud within these programs or across the health care industry generally.”

A 2015 GAO report says Medicare, Medicaid, and CHIP lost approximately $78 billion to improper payments in 2014. CHIP and Medicaid rates of improper payments were 6.5 percent and 6.7 percent, respectively, and 9.9 percent of every Medicare dollar was improperly paid, the report said.

HR 3716 is “an important step in the right direction for the House’s overall efforts to improve healthcare delivery, cut runaway spending, and reduce waste, fraud, and abuse,” McGee said.

Dustin Siggins ([email protected]) writes from Washington, DC.

Internet Info:

“Congressional Budget Office Cost Estimate: H.R. 3716 Ensuring Removal of Terminated Providers from Medicaid and CHIP Act,” U.S. Congressional Budget Office, February 2, 2016:

“Health Care Fraud: Information on Most Common Schemes and the Likely Effect of Smart Cards,” U.S. Government Accountability Office, January 2016:

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