This week, the U.S. Attorney General and the Secretary of Health & Human Services announced the launch of a partnership between the federal and state governments, private healthcare insurance companies and other healthcare anti-fraud groups to prevent healthcare fraud. The effort is aimed to safeguard healthcare dollars.
The partnership will share information to improve detection of fraudulent healthcare billing. “A potential long- range goal of the partnership is to use sophisticated technology and analytics on industry-wide healthcare data to predict and detect healthcare fraud schemes.” [Press Release, U.S. Dept. of HHS (July 26, 2012)] According to the Secretary of Health & Human Services, by sharing information across payers—public and private– potential fraudulent activity can be stopped:
In the past, we followed a ‘pay and chase’ model, paying claims first – then only later tracking down the ones we discovered to be fraudulent. … Since we have put this system in place, it has stopped, prevented, or identified millions in payments that should never have been made. And because the system is designed to get smarter over time, as it analyzes more data, it’s only going to be more effective in the future. [Speech of Secretary of U.S. HHS (July 26, 2012)]
The Affordable Care Act permits enhanced screening of physicians who treat Medicare and Medicaid patients and the suspension of payments to physicians engaged in suspected fraudulent activity. This public-private partnership will build on these fraud prevention tools.
The Federal Government has recovered fraudulent payments of $10.7 billion over the past three years. Read more about fraud prevention under the Affordable Care Act.
MSNJ’s delegation to the American Medical Association attended its Annual House of Delegates meeting last month in Chicago. The AMA House of Delegates considered several resolutions submitted by the New Jersey delegation. As a result of testimony by MSNJ’s leadership, as well as support from a number of other state delegations, the AMA created a new policy concerning national drug shortages.
The new policy will require manufacturers of FDA approved drugs to give the agency at least six months advanced notice, or as soon as practicable, of anticipated discontinuance of the manufacture or marketing of a product. The policy also supports the creation of a task force to enhance the HHS Secretary’s response to preventing and mitigating drug shortages and to create a strategic plan to address ongoing aspects of drug shortages. The AMA has pursued federal legislation over the past year, due in part to MSNJ’s advocacy on this issue.
The AMA House of Delegates also combined MSNJ’s resolution on the Sunshine Act with that of the Nevada delegation adopting a substitute resolution that requires the AMA to continue efforts to minimize the burden and CMS’s unauthorized expansion of the Sunshine Act. It also requires AMA to work with CMS to create a physician comment section on the “Physician Payments Sunshine Act” public database.