Republicans Ask CMS to Increase Fraud Efforts

In a letter to CMS sent by House Ways and Means Health Subcommittee Chairman Wally Herger, Ways and Means Oversight Subcommittee Chairman Charles Boustany, Senate Finance Committee ranking member Orrin Hatch and Finance Committee member Tom Coburn, the members asked the agency to beef up fraud and abuse efforts, particularly those who false bill and set up fake storefronts.  They asked for a description of CMS efforts to identify and detect nominee owners; what safeguards Medicare contractors use in verifying identities of practitioners and owners; and a description of the process CMS uses to determine which categories of providers and suppliers are at high risk of committing fraud.

MedPAC Recommendations on Medicare FFS Benefit Design

The Medicare Payment Advisory Commission announced they will recommend several means by which Congress could reform the traditional Medicare fee-for-service system to reduce beneficiary exposure to the risk of high out-of-pocket spending and to create incentives for beneficiaries to make better decisions about their use of medical services.  The recommendations, to be included in the June MedPAC report to Congress, would allow HHS to combine the deductible for Part A and Part B and replace the current coinsurance with a copayment that would vary by type of service and provider.  The commissioners discussed a possible out-of-pocket cap of about $5,000 that would be made budget neutral through an additional charge on Medigap supplemental coverage.  The commission also discussed a Medicare/Medicaid dual-eligible demonstration and suggested that so-called “passive” enrollment in managed care plans could be frightening to individuals and may pose problems with their care.  The target date for managed care plan selection under the demo is set for July 30.

LTC Facility Relief

CMS announced that the agency will not proceed with a proposed requirement that nursing homes and other long-term care facilities hire independent pharmacists to review resident medications in an effort to reduce the overprescribing of antipsychotics and other drugs.  The agency said it will further study the issue after receiving comments that physician prescribing patterns could be driving the issue, not pharmacists.

Home Visitation Grants

HHS announced that ten states will receive Maternal, Infant and Early Childhood Home Visiting Program grants of $72 million to establish and expand home visitation programs for pregnant women, parents, caregivers and children.

FDA Issues

The Senate HELP Committee released a public draft, the Drug Approval and Patient Access legislation, which is designed to accelerate FDA approval of breakthrough drugs and to aid in the development of consensus policy proposals to accompany the omnibus medical product user fee reauthorization legislation the committee wants to have enacted before the current laws expire on September 30th.  The committee said it will release additional drafts in other policy areas in upcoming weeks.

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