Medicare Fraud & Health Care Reform

The AP reported today that "The government paid more than $47 billion in questionable Medicare claims including medical treatment showing little relation to a patient's condition, wasting taxpayer dollars at a rate nearly three times the previous year." Senator Chuck Grassley, an Iowa Republican, announced that he had introduced a bill to fight Medicare fraud. Sen. Grassley states that

Right now, federal law requires that Medicare send payment within a very short time frame, even when there is risk of fraud, waste or abuse. “Because of this prompt payment rule, the government puts itself in a position of having to pay and chase Medicare fraud, instead of working to prevent it in the first place. That doesn’t make any sense,” Grassley said, “and it’s no way to manage Medicare’s resources.”

Slowing down the process would help reduce fraud and simple payment errors, in my view. That's why I'm concerned that the healthcare reform bills approved by the House and pending in the Senate would require the Department of Health and Human Services to issue new HIPAA transaction standards that would allow for near real time eligibility and claim payment determinations. Calling Tony Soprano and crew. (It's also ironic that HHS has not completed issuing the HIPAA transaction standards that Congress directed in 1996. The government simply should not be creating technology standards.)

That's why I chuckled to myself when I read a Govexec.com article about how

At the Holiday Park Senior Center in Wheaton, Md., Democratic Rep. Chris Van Hollen, tried to assure a crowd of about 200 people, mostly retirees, that current health care reforms under consideration would not have an adverse effect on their federal health benefits. Many current and former federal employees reside in Van Hollen's Montgomery County congressional district.

This two thousand page piece of legislation is bound to unexpected effects on the FEHB Program. For example, according to the article, "Van Hollen said the public option would expand the choices available to FEHBP enrollees by encouraging insurers to lower their prices for everyone." The public option, assuming that its premiums are more attractive than FEHB plan offerings, will lead to adverse selection against the FEHBP and higher rates for those who stay in the program.