Join us on April 1st, 2015 at 10:00am as Congresswoman Lois Frankel discusses the Medicare Fraud Act of 2014. At this event, you will learn what to look for to prevent fraud. Wondering what the Medicare Fraud Act entails? Below is a one-page summary:
H.R. 5340, the Fighting Medicare Fraud Act of 2014
The Fighting Medicare Fraud Act closes loopholes and fills gaps in the law that criminals have used to steals billions of dollars from Medicare. Specifically, H.R. 5340 would do the following:
1. Closes a loophole that allows CEOs and parent corporations to keep defrauding Medicare even after the organizations were caught and punished for prior offenses. Current law allows the federal government to ban corrupt companies and officials from billing Medicare. However, due to an oversight in the law, a crooked official can resign during a fraud investigation and still have the ability to later bill Medicare. Even if the former company is found guilty, the official can join a new company and launch a fraud scheme. Parent companies affiliated with fraudulent entities can also continue to bill Medicare through this loophole. For example, a shell subsidiary of a pharmaceutical company recently pled guilty to fraud and the parent company paid $2.3 billion in fines. Although the case involved admitted criminal conduct, the parent company continues to bill Medicare. This section would give the federal government greater authority to keep corrupt officials and parent companies out of the Medicare program.
2. Adds a new penalty of up to 15 years in prison for stealing or selling Medicare ID numbers. Currently, there is no specific federal offense for this activity. Yet many Medicare fraud conspiracies have as a core component the illegal distribution of Medicare ID number. One conspiracy totaling $223 billion of fraudulent billing involved cash kickbacks for obtaining Medicare ID numbers. Adding a new offense will help authorities crack down on criminals who target seniors.
3. Requires Medicare Advantage (MA) and prescription drug plans to report within 60 days to the proper authorities any incidences of fraud. Under current law, MA organizations are not required to report potential incidences of fraud and abuse. In a 2012 report, the independent HHS Office of Inspector General questioned whether all MA organizations are adequately identifying and reporting potential fraud and abuse. The report revealed that 95% of all reported cases of fraud were made by only three of the 178 organizations studied, and 19% of MA organizations reported nothing at all.