Medicare receives increased scrutiny regarding fraud, payment issues

USA Today: "Proposed regulations being unveiled today seek to crack down on Medicare and Medicaid fraud by subjecting operators of certain medical firms to fingerprinting and stopping payments when credible fraud allegations are made, documents show. The rules would give federal health officials key powers to identify fraud early and reduce the estimated $55 billion in improper payments made each year in the Medicare and Medicaid programs, said Peter Budetti, director of the new anti-fraud office at the federal Centers for Medicare & Medicaid Services" (Young, 9/20).

Meanwhile, The Wall Street Journal reports that "[m]any families are jeopardizing their parents' outpatient and prescription-drug Medicare coverage—mainly because the rules are more complicated than they realize. The confusion is expected to get worse next year, with the first wave of baby boomers turning 65 and with changes in Medicare under the new health-care law. … One critical factor that often trips up adult children: Medicare Part D drug coverage is tied to the area where the beneficiary lives" (Greene, 9/18).

In other news, American Medical News notes that the "American Medical Association wants the bipartisan debt commission created by President Obama to consider sending Congress a proposal to repeal the sustainable growth rate formula before lawmakers recess in early October to head home for the November midterm elections. The National Commission on Fiscal Responsibility and Reform is set to meet Sept. 29, and the AMA is strongly urging commission members to consider a proposal to permanently reform the SGR, which helps determine Medicare payments to physicians." Congress passed in June a 2.2% increase to avert a 21% pay cut for physicians. But, without more intervention from lawmakers, "physician rates are scheduled to decline 23% on Dec. 1, an additional 6.5% in January 2011 and 2.9% more in 2012" (Silva, 9/20).

Orlando Sentinel: "Many older voters who grew up in the shadows of the Great Depression have turned against President Barack Obama and Democrats in Congress this election year, partly because of fears that the government will bury younger generations under a mountain of debt. Their worries over a national debt that will reach $1.3 trillion this year, along with wariness about the new health-care law, could make a crucial difference in pivotal congressional races in Florida." In Florida, seniors make up one-fourth of the state's voters, and they are considered more likely to turn out for midterm elections than their younger counterparts (Gibson, 9/19).

---

This article was reprinted from khn.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.