Reducing waste, fraud and abuse in our health care system saves taxpayer dollars and protects the health care investments made by individuals, businesses and government. The non-partisan Congressional Budget Office estimates that every dollar invested to fight fraud yields approximately $1.75 in savings. As any business owner will tell you, that is a powerful return on investment.

The health care reform bill strengthens Medicare and Medicaid’s existing compliance and enforcement tools, reducing fraud and abuse and saving billions of taxpayer dollars. Specifically, the bill makes improvements in the following key areas:

New funding to fight fraud and abuse

1. Provides $700 million over the next decade in new funds to fight fraud.
2. Increases funding for the Health Care Fraud and Abuse Control Fund and the Medicaid and Medicare Integrity Programs to provide new resources to fight fraud.

Improved screening to catch and punish fraudulent providers and suppliers

1. Allows the Centers for Medicare and Medicaid Services to conduct background checks, site visits and other enhanced oversight to weed out fraudulent providers before they start billing the program.
2. Creates a national pre-enrollment screening program for all providers and requires disclosure of prior association with delinquent providers or suppliers.
3. Places new controls on high-risk programs such as home health services or durable medical equipment in order to ensure that only Medicare and Medicaid providers in good standing can provide these services.

Strengthens Medicare and Medicaid program requirements for providers, suppliers and contractors

1. Requires providers and suppliers to adopt compliance programs as a condition of participation in Medicare and Medicaid.

Establishes new penalties to deter fraud and abuse

1. Creates new penalties for submitting false data on applications or false claims for payment as well as for obstructing audits or investigations related to Medicare or Medicaid.
2. Establishes new penalties for Medicare Advantage and Part D plans that violate marketing regulations or submit false bids, rebate reports or other documents to the Centers for Medicare and Medicaid Services.

Aggressively monitors Medicare and Medicaid for evidence of fraud, waste and abuse

1. Creates a comprehensive Medicare and Medicaid provider/supplier data bank to conduct oversight of suspect utilization, prescribing patterns and complex business arrangements that may conceal fraudulent activity.
2. Narrows the window for submitting Medicare claims for payment and requires electronic payments in order to decrease the opportunities for “gaming” the system.
3. Creates new data sharing arrangements to help the Centers for Medicare and Medicaid Services and other agencies identify fraudulent providers.