Policies to Crack Down on Waste, Fraud and Abuse
The House and Senate health reform bills contained an unprecedented array of aggressive new authorities to fight waste, fraud and abuse. The final health reform legislation built on those provisions by incorporating a number of additional proposals that are either part of the Administration’s FY 2011 Budget Proposal or were included in Republican plans.
Community Mental Health Centers.
Health reform ensures that individuals have access to comprehensive mental health services in the community setting, but strengthens standards for facilities that seek reimbursement as community mental health centers by ensuring these facilities are providing appropriate care and not taking advantage of Medicare patients or the taxpayers. (Source: H.R. 3970, “Medical Rights & Reform Act” (Kirk bill))
Additional Funding to Fight fraud, Waste and Abuse.
Health reform increases funding for the Health Care Fraud and Abuse Control Fund by $250 million over the next decade.
Medicare Prepayment Medical Review Limitations.
Health reform streamlines procedures to conduct Medicare prepayment reviews to facilitate additional reviews designed to reduce fraud and abuse.
Provides for a 90-day Period of Enhanced Oversight for Initial Claims of DME Suppliers.
Health reform requires a 90-day period to withhold payment and conduct enhanced oversight in cases where the HHS Secretary identifies a significant risk of fraud among DME suppliers.