GOP lawmaker calls for tougher fight against Medicare fraud

ADVERTISEMENT
Pitts leads the House Energy and Commerce Subcommittee on Health, which held the hearing.

He called on the Center for Medicare and Medicaid Services (CMS) to utilize predictive analytics technology and test the effectiveness of current fraud prevention efforts.

Lawmakers debated the merits of a bipartisan bill, the Medicare Common Access Card Act, that would establish a "smart card" pilot program.

The logic is that the cards, used in tandem by Medicare patients and providers to verify services rendered, would cut down on improper billing.

But some experts expressed concerns about the idea, saying it would burden doctors by requiring them to equip their offices with new technology.

This was the position of the American Medical Association, which submitted a letter to the panel.

Kevin Fu, a computer scientist at the University of Massachusetts Amherst, also testified, arguing that a "smart card" system would be prone to hacking, has posed problems in other countries and may be a challenge for the elderly.

"A key lesson from modern cybersecurity research is that security technology alone will not solve a security problem unless there is effective policy implemented to control fraud," Fu said, according to prepared testimony.

"Without first plugging the policy loopholes that lead to Medicare fraud, the federal government will likely switch from maintaining one costly, fraud-prone system to instead maintaining two costly, fraud-prone systems." 


House and Senate versions of the Medicare Common Access Card Act were introduced in 2011 and have 25 and six co-sponsors, respectively.

In a memo, GOP staff with the Energy and Commerce Committee cited estimates that Medicare and Medicaid fraud adds about $98 billion to the programs' bills each year.

The memo also cited an Institute of Medicine study finding that unnecessary services, excessive administration costs, fraud and other issues amounted to about 30 percent of total U.S. health spending in 2009.