U.S. Senate

  • On July 22, 2015, the Senate Special Aging Committee convened a hearing entitled “The Doctor’s Not In: Combating Medicare Provider Enrollment Fraud”. Witnesses for the hearing included Shantanu Agrawal, M.D., Deputy Administrator and Director, Center for Program Integrity (CPI), Centers for Medicare and Medicaid Services (CMS); Seto J. Bagdoyan, Director, Audit Services, Forensic and Investigative Service, United States Government Accountability Office (GAO); and Katherine Leff, R.N.; Director, Special Investigations, CareSource Management Group. During the hearing Bagdoyan discussed the results of a GAO report entitled “Medicare Program: Additional Actions Needed to Improve Eligibility Verification of Providers and Suppliers”. To produce the report, GAO examined the implementation of four enrollment screening procedures that CMS uses to prevent and detect ineligible or potentially fraudulent providers and suppliers from enrolling into its Provider Enrollment, Chain and Ownership System (PECOS). Bagdoyan reported that two of CMS's procedures appear to be working to screen for providers and suppliers listed as deceased or excluded from participating in federal programs or health care–related programs. However, GAO identified the following weaknesses in the other two procedures: CMS's verification of provider practice location and physician licensure status. More information on the hearing may be found here.
  • On July 23, 2015, the Senate Health, Education, Labor and Pensions (HELP) Committee convened a hearing entitled “Achieving the Promise of Health Information Technology: Information Blocking and Potential Solutions”. Witnesses for the hearing included David C. Kendrick, MD, MPH, Chair, Department Of Medical Informatics, University Of Oklahoma, and CEO, MyHealth Access Network; Michael J. Mirro, MD, FACC, FAHA, FACP, Past Chair, Medical Informatics Committee, American College Of Cardiology, Chief Academic / Research Officer, Parkview Mirro Center for Research and Innovation; David C. Kibbe, MD MBA, President And CEO, DirectTrust Senior Advisor, American Academy of Family Physicians; and Paul M. Black, MBA, President, Chief Executive Officer And Director, Allscripts. More information on the hearing may be found here.
  • The Senate Finance Committee on Tuesday approved in a 23-3 vote a $95 billion tax extenders package that would retroactively renew 52 expired provisions through the end of 2016. More information may be found here.

House of Representatives

  • On July 22, 2015, the House Ways and Means Health Subcommittee convened a hearing to discuss issues involving hospital payment, rural health, and beneficiary access to care. The sole witness for the hearing was Mark Miller, Staff Director of the Medicare Payment Advisory Commission (MedPAC). During the hearing Subcommittee Chairman Kevin Brady (R-TX) expressed interest in exploring site-neutral payment reforms, noting that MedPAC has found that for some cases, Medicare pays as much as $4,000 more per case simply because there is a discrepancy regarding a patient’s inpatient or outpatient status. He added that because the inpatient and outpatient payment systems are so different, it is difficult to get an accurate assessment of what is driving this trend. “Clearly,” he said, “this is an area ripe for reform”. Brady also cited MedPAC testimony regarding indirect medical education (IME) and disproportionate share hospital (DSH) payments—two 'add-on' payments that certain hospitals receive to help offset the cost of teaching medical students or treating a larger-volume of uninsured or underinsured patients. “I believe both of these programs are critical and need to be designed to deliver the most targeted payments possible,” Brady stated, adding that, “As arbitrary add-on payments, they are not achieving their mission.” More information on the hearing may be found here.
  • On Wednesday July 22nd, the full House Veterans Affairs Committee convened a hearing on Department of Veterans Affairs plans to address potential hospital shutdowns if pending budget shortfalls are not resolved. The sole witness was Robert McDonald, Secretary of VA. More information on the hearing may be found here.
  • The House Energy & Commerce Committee was scheduled to a hearing entitled "An Overdue Checkup: Examining the ACA's [Affordable Care Act] State Insurance Marketplaces” today, Friday July 24th. However, it was postponed due to a scheduling change in the House of Representatives. Additional information will be made available here.