New Bill to Boost Fight Against Medicare Fraud

New legislation would give payers more time to reimburse providers for Medicare claims when waste, fraud, and/or abuse are suspected.

Senator Chuck Grassley introduced the Fighting Medicare Payment Fraud Act of 2009 on Nov. 16.

“As Medicare spending continues to skyrocket, everything possible must be done to protect Medicare dollars from being lost to fraud, waste, and abuse,” Grassley said in a press release.


If passed, the bill would give the Secretary of Health and Human Services (HHS) authority to extend the time period in which Medicare Part A/B claims must be paid under the prompt payment rule when waste, fraud, or abuse is suspected. The Secretary would have up to one year to conduct more detailed reviews of questionable claims submitted by suppliers or providers in a particular geographic area or however long was necessary for individual providers.

The Grassley bill also requires the Office of Inspector General (OIG) to recommend to the HHS Secretary, on at least an annual basis, categories of providers or suppliers where additional scrutiny is needed; and includes a provision that requires the Secretary to respond to all OIG recommendations of this nature.

“We’ve seen in reports revealed this fall how the Department of Health and Human Services turned a blind eye for many years to alerts from the Inspector General about Medicare fraud,” Grassley said. “This provision in the bill is intended to make sure the Department of Health and Human Services can’t get away with ignoring those kinds of alarms.”

Any way you look at it, “It is one more layer of regulations,” said Deborah Grider, CPC, CPC-I, CPC-H, CPC-P, CEMC, COBGC, CPCD, CCS-P, AAPC vice president of strategic development. “It validates even more the need for certified coders and, even more so, certified auditors.”

You can read the Grassley bill online in its entirety, as well as the press release on Grassley’s Web site.

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3 Responses to “New Bill to Boost Fight Against Medicare Fraud”

  1. Judith A. Hale, CPC says:

    Who do we turn to? Several of our Mothers are in a local skilled(?) nursing facility. The attending physician makes rounds as required but spends one minute or less with each patient. She has been consistently coding 99310. That in itself is upcoding. She bills Medicare Part B through her private practice using her own coders. She does not dictate on-site or write any notes after seeing the patient. She is not accompanied by a PA or NP. When we ask for medical documention, she can provide nothing. Her response is the nursing facility keeps records. That is not in compliance with Federal Law. We have the progress notes from the nursing home. Occasionally the physician’s initials appear on a prescription order. Other than that…nothing. She has been doing this for seven years. We have reported her to Medicare, OIG, the FBI and they all say it’s a small issue. I didn’t know over $2M was a “small issue.”
    Does anyone have any suggestions regarding reporting this to an entity that might be interested? Senator Grassley? Help!!!

  2. juwanna helms says:

    I heard it was going to be mandated that to bill a physician or facility must use a certified coder come 2013. I would love to know if this is going to happen. I have been a biller for 11 years and I am studying to take the CPC. I think it would cut down on so many claims being sent as not clean claims. Cut down the labor on reprocessing. I would love a response if this is going to happen.

  3. brad says:

    I’m not seen this in any of the legislation.

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