Rep. Sam Graves sponsors Medicare Fraud Enabling Bill

Rep. Sam Graves sponsors Medicare Fraud Enabling Bill

Legislation pending in Congress would gut effective anti-fraud efforts in the Medicare program, alleges the Council for Citizens Against Government Waste, EHR Intelligence reports. The legislation “would have a chilling effect on the RAC ( Recovery Audit Contractors) program, one of the government’s few successful initiatives to identify and recover waste, fraud, and abuse in Medicare,” EHR Intelligence stated.

Veteran observers of Congress know that vigilance is key. Just when appears the grassroots efforts might have nipped a terrible bill in the bud, it comes back with a vengeance.

Consumer advocates are drawing attention to a bill heavily pushed by the big hospital lobby that would enable Medicare fraud, resulting in billions of additional government dollars wasted on improper payments.

The bill, introduced by Rep. Sam Graves (R-MO), who is rated a fairly liberal Republican by the Madison Project analysis of his voting record, would gut an audit program that has identified billions of dollars in Medicare fraud at the beck of call of hospitals that would otherwise profit from that fraud.

The legislation, the “Medicare Audit Improvement Act,” (“improvement” here does not mean finding more fraud), already has 47 co-sponsors in the House.

The bill is co-sponsored by a number moderate to liberal Republicans as well as many Democrats, Real Clear Politics reports in listing the co-sponsors. Notably, not a single member of the GOP Doctors Caucus, a group of former doctors in the House who know healthcare well, has signed on.

The legislation targets the “Recovery Audit Contractors” (RAC) program, in which the government pays auditors a commission for successfully identifying fraudulent Medicare payments. Medicare annually issues roughly $50 billion a year in fraudulent payments, according to the Mercatus Institute, which is, for example, about twice the annual Gross Domestic Product of Paraguay.

Healthcare providers are fighting back against the RAC program and support the Graves bill, Forbes magazine reports.

(T)hey are fighting back in Congress. The Medicare Audit Improvement Act (S. 1012/H.R. 1250), which has bipartisan support in both houses of Congress, seeks to limit the powers of RAC auditors, even impose penalties upon them if they act improperly. These same auditing companies are none too happy about the bill, and claim it will cost the federal government billions if passed,” Forbes reported.

Consumer advocates remind us voters didn’t send them to Washington to enable Medicare fraud. Rep. Tim Huelskamp (R-KS), is an outspoken conservative who received a cool $1000 donation from the hospital lobby eight days after he signed on as a cosponsor. In fact, a close look at the list reveals numerous lawmakers who received donations very near to the time they cosponsored the bill – as well as many members who will face competitive elections and could really use the cash. Perhaps it’s not to cynical to see that the two are related.

Those payments go to hospitals who are essentially using improper payments to pad their profits, critics of the bill say, and don’t react kindly when meddlesome auditors inform the government those payments were actually illegal.

The hospitals, in turn, have vociferously complained that they are faced with overwhelming paperwork requirements in trying to keep up with auditors’ document requests. Maybe that is worth it if it effectively finds $50 billion in Medicare fraud.

There is something quite interesting about this issue. A top government official recently revealed at a congressional hearing that 51 percent of the hospitals’ appeals of the RAC audits were filed by five hospitals. So, only a small group of hospitals are asserting this is a problem, that they want to be fixed, regarding the RAC audit process.

Medicare fraud certainly is a real issues, as the Inquisitr reported last month, 243 individuals were charges with $712 million in false filings under Medicare. The Attorney General stated that this was the largest ever prosecution of health care fraud. Given the scope of the problem with Medicare fraud, it is understandable that if the RAC program is effective there will be significant opposition to legislation that might gut the program.

Is the Graves bill really a solution to a problem, or perhaps an elimination of a solution that some think is a problem? Consumer advocates and grass-roots activists will ultimately send a message to members of Congress, and it will remain to be seen if so-called Medicare Audit Improvement Act becomes laws or is defeated in Congress. Opponents of the bill clearly see it as an attempt to eliminated an effective anti-fraud program.

[Photo of Cong. Sam Graves from his official portrait via Wikipedia.]