If you listen to the news pundits you are led to believe that health care reform is not a done deal. Upon closer inspection we find that implementation is well underway and that current initiatives are changing basic assumptions about patient care.
The Steward Group finds that current initiatives are changing the basic assumptions about US health care
In anticipation of the full roll-out of the Patient Protection and Affordable Care Act, the executive branch of the federal government is steadily changing the conventions that have defined US health care. In this issue of Verity Reports, we focus on two conventions that were knocked down within the last few weeks:
- Medicare providers don’t have to take fraud seriously.
- Health reform doesn’t give hard-working Americans a safety net.
Medicare fraud: It is time to take it seriously
The medical billing community already knows that Medicare carriers have become increasingly vigilant, however, health reform has raised the stakes. The Centers for Medicare & Medicaid Services (CMS) is changing from a “pay and chase” to a fraud prevention strategy.
In a press release the DOJ reports that the “Affordable Care Act requires providers and suppliers to establish plans detailing how they will follow the rules and prevent fraud as a condition of enrollment in Medicare, Medicaid, or CHIP.”
Suppliers of durable medical equipment, home health agencies, and Community Mental Health Centers (CMHCs) have been targeted as high fraud risks.
The Steward Group conducts trends analyses to predict how an industry and consumer needs might change over time.
Since May 2009, HEAT, the Medicare Fraud Strike Force, composed of federal and state staff from the Office of the Inspector General and Department of Justice, has charged 465 defendants with defrauding Medicare of more than $830 million dollars.
For example, Drs. Juan De Oleo and Rosa Genao face possible prison sentences of a maximum of 10 to 20 years for health care fraud, money laundering, and the destruction or alteration of records. In addition, government agents are recruiting the assistance of Medicare beneficiaries to help stop fraudulent charges to the program. A fraud hotline can be called 24/7 to report program abuses.
Government funded healthcare: Benefiting the middle-class
Only a few days ago, Kathleen Sebelius, Secretary of the Department of Health and Human Services announced that nearly 2,000 employers were accepted into the Early Retiree Reinsurance Program (ERRP). Modern Healthcare reports that the “approved applications represent nearly every sector of the economy: 32% from businesses, 26% from state and local governments, 22% from union sponsors, 14% from schools and other educational institutions, and 5% from not-for-profits. Reimbursements will begin this fall for the early retirees of these companies. ” Modern Healthcare.com.
New rules for new health care
With just these two programs, the landscape of US health care is already changed.
The White House administration has brought Medicare fraud penalties into the realm of street crime. It has also redefined Medicare as a program that is not just for the elderly and may make supporters of the very people who are most likely to believe that health reform will not benefit to them.
Image: Pete Souza
Verity Reports 