A press release from Congressman Randy Hultgren:
Combating Waste, Fraud, and Abuse in Medicare and Medicaid with the PRIME Act
Washington, DC – In an effort to combat waste, fraud, and abuse in the Medicare and Medicaid programs, U.S. Representative Randy Hultgren (IL-14) has cosponsored the Preventing and Reducing Improper Medicare and Medicaid Expenditures (PRIME) Act of 2015, a bipartisan bill to amend titles XVIII and XIX of the Social Security Act.
“Americans rely on Medicare and Medicaid for healthcare access, but these expensive programs lose billions in waste, fraud and abuse every year, ratcheting up the bill on taxpayers,” said Rep. Hultgren.
“I am encouraged that both sides of the aisle have come together to stop people from taking advantage of these programs, and improving their efficiency and transparency.
“Putting these programs on sound fiscal footing and protecting our seniors requires rooting out weaknesses that potential scammers can exploit.
“I want to thank my friend and fellow Illinoisan Rep. Peter Roskam (IL-06) for his leadership to restore fiscal accountability to our social safety net programs for the benefit of Illinois.”
The Government Accountability Office (GAO) shows that improper Medicare payments are on an upward trend. In 2012, the FBI estimated they may total anywhere from $75 to 250 billion.
To reverse these alarming trends, the PRIME Act:
- Phases out the antiquated “Pay-and-Chase” system by better incentivizing Medicare Administrative Contractors (MACs), who are the first line of defense against fraudulent claims.
- Prevents Medicare thieves from pretending to be doctors by demanding that HHS enhance Federal Medicare and State Medicaid data matching to ensure that databases are consistent for both bad actors and unreported deaths.
- Incentivizes Medicare contractors to avoid overpayments and errors by linking contract payments to accuracy goals for Medicare contractors and defining penalties for not meeting those goals.
- Creates stiffer penalties for fraudulent use of patient or provider identities.
- Encourages seniors and other beneficiaries to report possible fraud and abuse in Medicare and Medicaid by building on and expanding the Senior Medicare Patrol program.