Feds say they recovered $1 billion in fiscal 2008

The U.S. Justice Department and HHS’ inspector general’s office recovered $1 billion in judgments and settlements in fiscal 2008 for the federal government, according to the annual report of the Health Care Fraud and Abuse Control Program. Under the Health Insurance Portability and Accountability Act of 1996, the departments are required to coordinate and issue reports on their efforts to fight fraud perpetrated against federal health programs. The reports are generally issued about a year after the close of the fiscal year they cover. In fiscal 2008, about $1.94 billion was returned to the Medicare Trust Fund as a result of enforcement actions in that year and previous years, and $344 million in Medicaid funds was returned to the U.S. Treasury. U.S. attorneys, meanwhile, opened 957 new criminal cases involving healthcare fraud, filed criminal charges against 797 defendants and won 588 convictions. The Justice Department’s civil division opened 843 new healthcare fraud investigations.
Modern Healthcare by Gregg Blesch, October 23, 2009


Health Care Reform Update 10.20.09

Five committees in the U.S. House and Senate have all completed work on comprehensive health care reform legislation. Now, action shifts to leadership in both chambers. Leaders in the House and Senate will decide the final version of the bill that ultimately goes forward for a final vote in each chamber.

The House
H.R. 3200 includes major health insurance reform provisions: guaranteed issuance, guaranteed renew-ability, no lifetime or annual limits on care, the elimination of pre-existing condition prohibitions, and other reforms. The bill also would create a health insurance “exchange” through which individuals could access qualified health plans.
Another crucial provision of H.R. 3200 is reform of Medicare’s Sustainable Growth Rate formula (SGR). These provisions are not perfect, but they would be meaningful steps forward—effectively preventing a 21 percent Medicare payment cut scheduled for all physicians beginning Jan. 2010.

The Senate
Sen. Max Baucus (D-MT), Chairman of the Senate Finance Committee, introduced his version of health reform legislation. The “America’s Healthy Future Act” which contains many of the same provisions as H.R. 3200 related to health insurance reforms. The Finance bill includes negotiated rates as a key feature of proposed health insurance “co-ops,” rather than payments based on Medicare rates. The other health care committee in the Senate, the Health, Education, Labor and Pensions (HELP) Committee finished its bill this summer. S. 1679, the “Affordable Health Choices Act,” includes a public plan that is not based on Medicare payment rates.

The Merge
Once House and Senate leaders finalize their respective health care reform bills, they must be voted on in each chamber. Then, the House and Senate must work together to reconcile any difference between their bills through a conference committee. The issue of a public plan is still not resolved, and many believe that there will be attempts to reinsert it in conference. Each body is expected to take up legislation in October.
Stay Tuned!