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Jim M.
Democrat WA 7

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  • Technical Corrections to Allow Agencies to Fight Fraud, Waste, and Abuse in the Medicare Program

    by Representative Jim McDermott

    Posted on 2014-01-09

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    McDERMOTT of washington in the house of representatives Thursday, January 9, 2014 Mr. McDERMOTT. Mr. Speaker, I rise today to introduce two technical corrections to the Affordable Care Act. These two bills provide minor technical corrections to avoid confusion and to ensure that regulators can effectively do their work in combatting fraud, waste, and abuse in the Medicare program. We need to extend the solvency of the Medicare program and to do so, we must ensure that the regulatory agencies are empowered to fully enforce provision to reduce fraud, waste, and abuse in the Medicare program.

    The first bill would allow certain physician extenders, including physician assistants, nurse practitioners, and clinical nurse specialists, to document that the face-to-face encounter required by the Affordable Care Act has occurred. The Affordable Care Act currently requires that a physician document that a face-to-face encounter has occurred, even though the law allows the face-to-face encounter to be performed by a physician extender. The face-to-face encounter is an important tool to combat fraud and abuse in the durable medical equipment context, and it is important to recognize the role that physician extenders play in many instances.

    The second bill would correct an error in the ACA that was carried over from an underlying law, which prevents regulators from stopping waste, fraud, and abuse. A provision in the Affordable Care Act intended to allow regulators additional discretion to impose a surety bond on home health agencies based on the volume of payments they received from the Medicare program. However, due to a drafting error in the underlying law that was inadvertently perpetuated in the Affordable Care Act, the bond that regulators can require from home health agencies is essentially capped at $50,000. For large providers, this amount is too low a sum to have a meaningful impact and directly contradicts Congress' intention to require a higher bond from home health agencies that receive substantial Medicare payments.

    We must continue our efforts to extend the solvency of the Medicare program. Fighting fraud is a nonpartisan issue. I urge my colleagues to support these technical correction provisions.


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