On March 2, 2011, Senator Charles Grassley (R-Iowa) proposed new efforts to enhance the federal government’s authority to combat Medicare fraud in a bill to enact the “Strengthening Program Integrity and Accountability in Health Care Act of 2011.” One of the bill’s key provisions would require Medicare claims and payment data to be available to the public organized by provider name, similar to how other federal spending data is presently disclosed to the public.

Other provisions proposed by Senator Grassley’s bill include:

  • making Medicare payment suspensions of providers involved in a pending fraud investigation mandatory rather than discretionary;
  • extending the time Medicare has to make prompt payment of claims to certain providers if the Secretary of Health and Human Services (HHS) makes a determination of a high likelihood of fraud or abuse;
  • creating an information-sharing program between the Federal Trade Commission (FTC), which maintains a database of identity theft complaints, and the Social Security Administration (SSA);
  • allowing the HHS Office of Inspector General (OIG) to exercise its permissive exclusion authority to exclude individuals from Medicare participation who have had past ownership or control interests with sanctioned entities;
  • requiring state Medicaid agencies to exclude individuals or entities from participation in the state's Medicaid program if they own, control, or manage an entity that: has unpaid or unreturned overpayments during a period to be specified by HHS; is suspended, excluded, or terminated from any state's Medicaid program; or is affiliated with an individual or entity that has been suspended, excluded or terminated from Medicaid participation during a period to be specified by HHS;
  • prohibiting state Medicaid agencies from providing reimbursement for covered outpatient drugs that are not approved by the federal Food and Drug Administration (FDA) unless the state first verifies with the FDA that such a drug is being legally marketed; and
  • requiring all individuals or entities that participate in federal health care programs to comply with requests for documents, information, or interviews by the chairmen or ranking members of specified congressional committees.

Senator Grassley commented before the Senate Committee on Finance that the new bill contains many of the provisions that he proposed in S. 2964 (111th Congress, 2010) that were not integrated into PPACA. He told the committee: “the federal government needs to be more effective in combating fraud, waste, and abuse. The federal government has simply made it too easy for bad actors to steal from these programs. It says a lot when you hear that organized crime groups have moved into health care fraud because it is profitable.”

The text of Senator Grassley’s proposed legislation is available by here. Senator Grassley’s press release which accompanied the bill is available by clicking here. His comments before the Senate Committee on Finance on March 2, 2011 are available by here.