Hultgren Takes on Medicaid & Medicare Fraud

From Congressman Randy Hultgren:

Hultgren Takes on Medicare and Medicaid Waste, Fraud and Abuse

Randy Hultgren

Randy Hultgren

This year marks the 50th anniversary of the Medicare and Medicaid social safety net programs. More than 50 million disabled Americans and seniors rely on Medicare for their health coverage. Medicaid offers health care coverage to five million low-income Americans.

But these safety nets suffer from troubling problems, including rampant waste, fraud and abuse. Scammers and fraudsters have targeted these programs for exploitation and personal gain – and have succeeded in many cases.

For example, according to the Government Accountability Office, improper Medicare payments are on an upward trend. In 2012, the FBI estimated they may total anywhere from $75 to 250 billion.

Putting these programs on sound fiscal footing and protecting our seniors and the disabled requires rooting out weaknesses that potential scammers can exploit.

To protect taxpayers – who are on the hook for such waste, fraud, and abuse – I have cosponsored the Preventing and Reducing Improper Medicare and Medicaid Expenditures Act of 2015, a bipartisan bill offered by my friend and neighboring colleague Rep. Peter Roskam (IL-06).

This bill targets some of the root causes that make these programs vulnerable to abuse.

For instance, it phases out the antiquated “Pay-and-Chase” system by better incentivizing Medicare Administrative Contractors, who are the first line of defense against fraudulent claims.

Many times Medicare thieves pretend to be doctors – sometimes deceased doctors – to receive improper payments.The PRIME Act demands that the Department of Health and Human Services enhance federal and state Medicare and Medicaid data-matching to ensure that databases are consistent for both bad actors and unreported deaths. The bill also goes after bad actors by creating stiffer penalties for fraudulent use of patient or provider identities.

Further, it 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.

There’s no doubt the larger burden these programs and their mandatory spending place on our national debt requires large-scale reforms, and I support improvements that put these programs on sound fiscal footing, while not changing benefits for those 55 years or older.

Until then, bipartisan legislation like the PRIME Act will stop people from taking advantage of these programs, and improve their efficiency and transparency.

I urge the House and Senate to work with President Barack Obama to improve government efficiency and quickly pass the PRIME Act.

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