Lawmaker introduces legislation to crack down on Medicare fraud

Rep. Lloyd Doggett (D-TX), ranking member of the House Ways and Means Health Subcommittee, has introduced two pieces of legislation meant to prevent Medicare fraud.

“Our healthcare system is plagued by a rising tide of healthcare fraud schemes — costing the Medicare program and American taxpayers tens of billions of dollars each year — and these are not victimless crimes. Medicare fraud and abuse risks the fiscal health of this vital lifeline for our seniors’ healthcare,” Doggett said in a statement.

The Medicare Fraud Detection and Deterrence Act would give additional authority to the Centers for Medicare & Medicaid Services to hold convicted Medicare fraudsters accountable and to stop repeat offenders. CMS would be permitted to deactivate a national provider identifier number “if the associated healthcare provider is convicted of waste, fraud or abuse and is added to the [Office of Inspector General] exclusions list.

As the law stands, according to Doggett, CMS cannot deactivate an NPI due to fraud unless the provider is the one to report fraudulent use of their own NPI. 

“Providers who have abused our system are still permitted to use their NPIs to bill Medicare,” Doggett said.

The congressman also introduced companion legislation, the Preventing Medicare Telefraud Act, meant to prevent tens of billions of dollars in telehealth-related fraud concerning high-cost durable medical equipment and lab testing. This bill would require an in-person appointment at least six months prior to a clinician ordering high-cost durable medical equipment or lab testing for someone. 

“The Department of Justice has convicted hundreds of providers and telehealth companies for fraud pertaining to the ordering of these services and equipment — schemes that cost taxpayers tens of billions of dollars,” Doggett said.

“The legislation would also authorize CMS to audit outlier clinicians who order durable medical equipment or lab tests at high rates. These audits will expedite the recovery of any fraudulent payments of taxpayer dollars,” he added. “Finally, the bill would require providers to use their own NPI when billing Medicare for a telehealth service to ensure greater transparency and data collection on which providers are ordering services and equipment. This provision is an extension of current policy for in-person services.”