Coalition: Legislation Limits Programs that Fight Waste, Fraud and Abuse in Medicare


June 3, 2013

Legislation Limits Programs that Fight Waste, Fraud and Abuse in Medicare

Senate and House legislation works to curtail the ability of auditors to carry out highly-effective waste, fraud and abuse prevention programs

Washington, D.C.The American Coalition for Healthcare Claims Integrity (ACHCI) issued the following statement regarding the introduction of companion legislation in the Senate (S. 1012) that would undermine the efficacy of the highly-effective recovery audit contractors that work with the Medicare program:

“It’s discouraging to see Congressional leaders who are committed to fiscal responsibility taking up arms against programs that save the government money,” said coalition spokesperson Becky Reeves. “We have a situation here where Congress is beholden to big industry instead of the American taxpayers.”

“Recovery audit contractors work independently, and at no cost to hospitals or the industry, to protect Medicare and Medicaid by identifying improper billings, which last year accounted for more than $65 billion in improper payments. Recovery audit contractors have found instances where hospitals have:

  • Submitted claims 10 times the amount of medication that was administered to the patient
  • Billed Medicare for drugs given to patients for off-label uses not approved by the FDA
  • Billed Medicare for durable medical equipment items such as a wheelchair when these items were not ordered by a physician

“These instances are tantamount to the government buying $600 toilet seats. As taxpaying Americans, we should all be outraged at the abuse of the Medicare system – abuse that will be more difficult to weed out if legislation like this is enacted. We hope that as Congress considers this legislation, it will also consider the effects that hamstringing a highly effective auditing program will have on the long-term solvency of the Medicare Trust Fund.”

For more information, please visit: www.properpayments.com.

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