The Trump administration proposed a budget increase of 19 million to aid in the fight against health care fraud. This showcases the continued (and heightened) importance of anti-fraud programs, especially compared to the suggested $18 billion in cuts to other health-care related programs. If approved by Congress, the budget increase will result in an increase in fraud and employee investigations, which in recent years, has shown a good return on investment for the Federal government.
The remaining funds will go to the Health Care Fraud and Abuse Control Program (HCFAC). This program manages all federal, state, and local law enforcement activities linked to health-care fraud and abuse. This additional funding will be split between the Centers for Medicare & Medicaid Services, the Department of Justice and the Health and Human Services Office of Inspector General.
The budget proposal included several recommendations to Congress to help reduce the threat of fraud:
- Cutting Medicare and Medicaid costs.
- Punishing doctors or physicians filing claims with inadequate documentation.
- Expanding Medicare’s previous program to include more services that have high risk for health fraud.
- Permitting Medicaid Fraud to receive equal funds to investigate fraud in home-health care settings.
- Halting the coverage and reimbursement of drugs prescribed to high risk patients or given by doctors with a history of overprescribing.
At a minimum, the proposal shows the Federal government’s continued emphasis on the importance (both financially and otherwise) of fighting non-compliant conduct. Providers should increase their compliance program efforts and ensure their programs are effective to minimize their risk of running afoul of applicable rules and regulations.