Medicare Compliance & Reimbursement

Legislators are feeling toothless -- that they don't have the statutory tools they should have - when it comes to clamping down on healthcare fraud that's rampant in the country. Finally there's hope on the horizon for them and that hope's come in the shape of the Health Care Fraud Enforcement Bill introduced by Sen. Ted Kaufman (DDE) and co-sponsored by Senate Judiciary Committee chairman Patrick Leahy (D-VT) and Committee members Arlen Specter (D-PA), Herb Kohl (D-WI), Chuck Schumer (D-NY) and Amy Klobuchar (D-MN).

As drafted, S.1959 aims to strengthen the U.S. government's capacity to investigate and prosecute waste, fraud and abuse in government healthcare programs and private health insurance. The bill is inspired both by legislation to crack down on mortgage fraud and other financial crimes, as well as healthcare reform legislation that would make the federal government an even bigger healthcare payor, Kaufman's press release explains. The bottom line of the press release is summed up the line, "[f]raud perpetuated against both public and private health plans costs between $72 and $220 billion annually, increasing the cost of medical care and health insurance and undermining public trust in our health care system."

Put in a nutshell, S. 1959 would:

• Beef up sentencing for health care fraud crimes;

• Define all claims made following illegal kickbacks as "false claims" under the False Claims Act;

• Clarify the "mental state" requirement for proving health care fraud. In other words, take out a lot of the confusion that surrounds "knowingly" and "unknowingly" in such cases; and

• Increase funding for the government to fight healthcare fraud.

Editor's note: To read the complete text of the press release, visit: http://kaufman.senate.gov/press/press_releases/release/?id=5e8767a9-e711-4f7a-8a52-27ad23e8fb53.) Read the complete text of the bill at http://www.whistleblowerlawyerblog.com/2009/10/new_health_care_fraud_enforcem_1.html.