Hultgren Signs on to Anti-Fraud Bill

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.

Randy Hultgren

Randy Hultgren

Peter Roskam

Peter Roskam

“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.


Hultgren Signs on to Anti-Fraud Bill — 5 Comments

  1. “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.”

    The United States population on July 4, 2014 was: 318,881,992.

    75,000,000,000 / 318,881,992 = $235 per person.

    250,000,000,000 / 318,881,992 = $784 per person.

  2. Huge money could be saved for our society if the legal profession were subjected to the same scrutiny (RAC audits) and civil penalties (law and politics exempt from liability for ‘non-economic’ damages)as the medical profession.

    Who is empowered to police overbilling and incompetence by attorneys paid with taxpayer dollars?

  3. Susan, if we keep electing more and more attorneys, we will increase the problem exponentially.

    We now even have an attorney for County Board Chair.

    We have an attorney for County Clerk. Next?

  4. As we allow the federal government to increase its portion of our gross national product, we will see similar increases in graft and corruption.

    “The daughter of the Rev. Jeremiah Wright, President Barack Obama’s former minister, was convicted by a federal jury Friday of laundering thousands of dollars from a $1.25 million state grant for a Chicago-based job-training program.”

  5. My suggestion is not that we hire any more attorneys. My suggestions are:

    1. Legislation to allow that the legal profession, when serving under any public-funds contract, be subject to RAC audits. (RAC auditors are for-profit auditors empowered to go into any doctor’s office who accepts Medicare or Medicaid, go through the books, and declare that the doctor overbilled and owes X-hundred-thousands-of-dollars to the Federal government. Doctors have the presumption of guilt upon RAC audit finding. Unless the doctor can pay six-figure legal fees to fight the RAC auditors assertions, the finding stands. Most docs settle, it is cheaper than fighting.)
    RAC AUDITORS ARE PAID A PERCENTAGE OF WHAT THEY RECOVER. If a RAC audit uncovers no ‘fraudulent billing’, they don’t get paid. The more they can claim a doctor owes, the more they earn.

    2. Legislation to remove the exemption attorneys now enjoy from civil liability for ‘non-economic’ damages. Medical professionals (and many other professions) are liable for the damage they cause to people, but legal professionals (and politicians, also) get a statutory exemption. Non-economic damages aren’t just pain& suffering or loss of consortium, they encompass all the expenses of trying to economically survive botched or fraudulent legal representation.

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