New Law Requires Medicare Providers to Use Anti-Fraud Enforcement Tools

Recently, the Medicare Access and CHIP Reauthorization Act of 2015 was signed into law by President Obama in an attempt to remedy the current Medicare reimbursement system. That system was established by the 1997 Balanced Budget Act, which set an overall target for Medicare spending that could be adjusted by reducing reimbursements to doctors or other providers.

Over the years, in an effort to ease fears that doctors would stop treating Medicare patients if payments were cut, Congress has enacted a number of temporary measures that resulted in a potential 21% pay cut needed to reach the Sustainable Growth Rate (“SGR”) target that was set to go into effect in April 2015.

The new law — known as the “doc fix” bill — permanently repeals the SGR target and replaces it with merit-based incentives and annual payment increases. In addition, the new law calls for the use of anti-fraud enforcement tools by Medicare providers to cut down on identity theft and wrongful payments.

To help stop identity theft, Medicare will stop using patients’ Social Security numbers as identification numbers. This will be phased in over the next four years.

To combat Medicare losses due to wrongful payments, Medicare Administrative Contractors will be required to establish an educational program that gives providers information on their most expensive and frequent payment errors.

The new law also mandates that the Secretary of Health and Human Services develop a new incentive program that rewards individuals for reporting Medicare fraud and abuse.

The Cogdell Law Firm is a boutique law firm focusing on large, complex business and criminal financial-related litigation, including white collar criminal defense, securities fraud, health care fraud investigation, criminal appeals and state criminal defense. When results matter most, contact Dan Cogdell at (713) 426-2244 or