Indy Standard

U.S. Senators Braun and Cassidy have introduced legislation aimed at addressing the issue of Medicare fraud. The bill proposes the implementation of an algorithm-based pilot period of oversight at the Center for Medicare and Medicaid Services (CMS), specifically targeting the irregular billing activity of certain products for the 5% of beneficiaries who already receive electronic notices.

Medicare fraud is a significant problem, with an estimated annual loss of $60 billion. This loss is attributed to both predatory healthcare professionals and anonymous organized criminals who exploit the system. These individuals engage in fraudulent activities such as charging Medicare beneficiaries for unapproved diagnostic tests and billing them for durable medical equipment products that they did not receive.

Senator Braun expressed his concern over the staggering loss of $60 billion, stating, "An annual loss of $60 billion is unacceptable. It’s time for CMS to strengthen their fraud detection process in order to stop the hemorrhaging of the Medicare trust fund."

Dr. Cassidy emphasized the importance of addressing Medicare fraud, especially considering the projected insolvency of the program in just eight years. He stated, "Medicare fraud should always be fought, but with insolvency only eight years away, we must be particularly careful about how we spend every dollar. This gives CMS the tools they need to fight fraud and to save the money to actually take care of patients."

Representative Schweikert, who introduced the companion legislation in the House of Representatives, highlighted the impact of Medicare fraud on beneficiaries and taxpayers. He stated, "Every year, too many Medicare beneficiaries fall victim to scammers who fraudulently charge them for medical supplies to take advantage of their reimbursements. This has led to Medicare losing billions annually and a depleted Medicare trust fund without much accountability for those at fault."

The Medicare Transaction Fraud Prevention Act, as proposed by Braun and Cassidy, aims to address these concerns. The legislation directs CMS to create a two-year pilot program overseeing the Medicare-covered purchasing of durable medical equipment and other diagnostic testing-related products. This pilot program would involve asking beneficiaries to verify certain purchases, providing CMS with increased access to predictive data and saving hundreds of millions of dollars. Importantly, the bill does not authorize any funding, and beneficiaries have the option to opt out at any time.

The introduction of this bill marks a significant step towards combating Medicare fraud and protecting beneficiaries and taxpayers. By utilizing innovative healthcare technologies such as artificial intelligence, the aim is to ensure that beneficiaries receive the care they deserve while preventing U.S. taxpayer dollars from being stolen by fraudsters.

With the proposed legislation, Braun, Cassidy, and Schweikert seek to strengthen the fraud detection process within CMS and safeguard the Medicare trust fund. By targeting fraudulent activities and implementing oversight measures, they hope to curb the annual loss of $60 billion and ensure the long-term sustainability of the Medicare program.