More Time for the Regulator to Find overpayments

In case you missed it....

PPACA allows States a year to recover over-payments that are not related to fraud or abuse cases. Before, States had 60 days to find the refund from the healthcare provider before it billed the Federal share of the bill. With a longer time of recovery, States will probably increasingly thorough and detailed in any Medicare/Medicaid submission.

Here is the CMS Release.

Update to the HHS auditing

"That’s why in addition to law enforcement actions like the ones we’ve taken today, we’ve also launched an ambitious national effort to block criminals at every step of the fraud process – from making it harder for corrupt providers to participate in Medicare or Medicaid to helping law enforcement agents analyze claims data to find suspicious patterns that could indicate fraud."

From the HHS Secretary speech. The government is planning on increasing auditing Medicare payments. Healthcare providers should expect some sort of auditing bill to be on the Hill soon.

More Payment Cuts coming soon

This time, the cut are not official but through the auditor saying you don't need to charge this or that. Expect longer turn around in payments and more payment cuts. The 60 billion is going to some hospital or practice. It is not coming out of thin air!

CQ Healthbeat: Senators Thursday also urged Medicare officials to do more to stop the up to $60 billion a year that goes out the door in improper payments in the program. "CMS officials are in the process of implementing provisions in the health care overhaul that will broaden auditing efforts aimed at reducing fraud. Congress also sent President Obama additional legislation Wednesday aimed at reducing improper payments in federal agencies. But CMS also needs to finish fixing vulnerabilities found by the Government Accountability Office (GAO) in its system, senators and experts said" (Adams, 7/15).

MedPac vs IPAB

Obama recently discussed the willingness to update MedPac into a super advisory committee. He says MedPac will be on “steroids” with this new Board, as in it will have much more power.

MedPac is an advisory group that was set up in 1997 from the Balanced Budget Act to monitor costs of Medicare payments. From this analysis, they would make recommendations. They are considered the "lobbyists" of the healthcare industry, from a payment perspective. While they main goal is to control costs, they have been supporters of better pay for doctors and hospitals (although incorrect on DSH payments).

Obama’s policy is to transform MedPac from a frankly powerless committee of smart people to a Board with the power to actually change things. Obama plans to create new independent panel called the Independent Payment Advisory Board. This 15 member board will have the power to act without the need of Congress. Congress can act against the IPAB but IPAB is allowed to do what it wishes unless Congress says no. This Board will have the power to cut payments where it deems necessary. Before MedPac issue advice about Medicare, but now MedPac will be partnered with IPAB, which will be a much more powerful body.

I think this is a little concerning. I am not really ever in favor for giving power to a Board without some sort of oversight. Having the ability to act and cut Medicare funding without the action of Congress seems like a heavy burden of responsibility. Not to mention, these individuals on IPAB will not be approved by Congress. The BBA does not set out that these individuals need to be approved by any congressional committee. The organizers within the government are saying that we do not “need” to have the IPAB members approved; I think shows some withheld intent.

This new 15 board panel will be made of full-time government employees. I am not sure why they need to be full-time because:

· They will only produce one report per year

· MedPac will produce a report 3 months after IPAB, what can happen in three months?

· Do we really need a full time 15 person board that just mulls over the same data CMH, HHS, MedPac, CHIP, etc. do already?

A more important question to ask is whether this panel replaces MedPac. I think people considered MedPac a good source of information and a good reference. The government usually never listed to their recommendations. I am not sure the IPAB will be any different. I think that most government officials have good intentions and believe it will help solve the problem. I just think that this IPAB is setting up to become the SEC of healthcare payments.

It does not surprise me that the government is transitioning power and information into the IPAB. It does what the US government likes to do all of the time: creates another regulatory power, creates another person someone needs to report too, costs money, prevents efficiency, and makes those in charge feel like they are doing something about the problem. It will indubitably be the day when the government thinks they are too big. When that happens, we will surely all be in trouble.