Members propose bipartisan reforms to stop Medicare, Medicaid waste

"The PRIME Act is what I like to call a win-win for those of us who are concerned about protecting Medicare and Medicaid by ensuring that these programs have the resources to provide excellent care for beneficiaries and that taxpayer dollars are spent responsibility and effectively," said Senate Homeland Security and Government Affairs Committee Chairman Tom Carper (D-Del.), the lead Senate sponsor of the bill.

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"Put simply, this bipartisan legislation builds on previous reforms by enacting additional common sense measures to better protect Medicare and Medicaid against instances of waste, fraud, and abuse."

Sen. Tom Coburn (Okla.), the top Republican on the committee, said the bill reflects the recommendations of many health experts, and is needed to ensure Medicare and Medicaid spending goes to the people who need healthcare access.

"Americans who rely on Medicare and Medicaid expect Congress to work together to reduce waste and fraud," Coburn said. "Improper payments divert scarce resources away from those most in need."

The legislation makes numerous reforms to the two programs, including the imposition of tougher penalties for Medicare and Medicaid fraud, and makes efforts to reduce improper payments under those programs.

The bill also seeks to phase out the "pay and chase" policy, under which the programs generally make payments without making an upfront effort to determine if the recipients of these payments are legitimate. A statement on Coburn's website said Medicare makes tens of billions of dollars in overpayments that are now spotted by private contractors, but only after the fact.

"The program's current pay-and-chase model pays out even suspicious Medicare claims, costing taxpayers billions of dollars," said Rep. Peter Roskam (R-Ill.), the lead House sponsor of the bill. "By combining 21st century technology and common sense solutions, the PRIME Act can help stop fraudsters in their tracks and make Medicare and Medicaid more financially stable for the long term."

The bill would take several other specific steps to stop wasteful Medicare and Medicaid spending. One example is a new effort by the Center for Medicare and Medicaid Services to ensure people don't steal the identities of deceased doctors and use them to claim reimbursements from the government.

The bill also requires Medicare officials to talk more with Medicare beneficiaries to help them spot waste and fraud, including by showing them how to review their Medicare statements for inaccuracies.

Rep. John Carney (Del.), the lead House Democrat on the bill, said he's hopeful that the bipartisan support for cutting waste in order to help seniors can win easy support in Congress this year.

"These days, finding areas where Democrats and Republicans can agree isn't always easy," he said. "But cracking down on waste, fraud and abuse is something we can all get behind."

The Senate bill is S. 1123, and is supported by Sens. Michael Bennet (D-Colo.), Chris Coons (D-Del.), Amy Klobuchar (D-Minn.), Mary Landrieu (D-La.), Claire McCaskill (D-Mo.) and Mark Warner (D-Va.). The House bill is H.R. 2305, and is backed by Reps. Ron Barber (D-Ariz.), Randy Hultgren (R-Ill.), Tom Reed (R-N.Y.) and Kurt Schrader (D-Ore.).

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