Congressman Seeks to Plug ‘Shocking Loophole’ Exposed by KHN Investigation

A U.S. lawmaker is taking motion after a KHN investigation uncovered weaknesses within the federal system meant to cease repeat Medicare and Medicaid fraud and abuse.

Rep. Lloyd Doggett (D-Texas) stated he determined to introduce a invoice within the Home late final week after KHN’s reporting revealed what he known as a “surprising loophole.”

“The power of fraudsters to proceed billing Medicare for companies is outrageous,” Doggett stated. “That is an apparent correction that’s wanted to safeguard our system. Wherever there are massive quantities of presidency cash out there, somebody tries to steal it.”

KHN discovered a laundry listing of weaknesses that enables individuals accused or convicted of fraud to simply sidestep bans imposed by federal officers. Amongst these gaps is the Facilities for Medicare & Medicaid Providers’ lack of authority to disclaim or revoke Nationwide Supplier Identifier, or NPI, numbers after federal regulators have prohibited an individual or enterprise from receiving funds from authorities applications.

Medical doctors, nurses, different practitioners, and well being companies use the distinctive, 10-digit NPI numbers to invoice and file claims with insurers and others, together with Medicare and Medicaid.

Taking away the NPI would “be equal of prohibiting a practitioner from working towards in complete,” Dara Corrigan, director of CMS’ Middle for Program Integrity, wrote in an e-mail response to questions on KHN’s investigation. CMS declined to touch upon Doggett’s proposed laws.

The invoice, HR 1745, would give CMS the authority to deactivate NPIs tied to anybody convicted of waste, fraud, or abuse and whose identify seems on the exclusions listing stored by the Workplace of Inspector Basic for the U.S. Division of Well being and Human Providers. The proposed legislation would additionally require CMS to implement suggestions that the inspector normal has made to enhance NPI reporting and supplier transparency.

“This strikes me as what needs to be a straightforward bipartisan measure,” Doggett stated, including that he had introduced the invoice in a face-to-face assembly with Rep. Jason Smith (R-Mo.), who chairs the Home Methods and Means Committee. Doggett additionally alerted that panel’s well being subcommittee chair, Rep. Vern Buchanan (R-Fla.).

“They each speak about the necessity to eradicate fraud, and that is one modest however vital option to do it,” Doggett stated. Neither Smith’s nor Buchanan’s places of work responded to requests for remark.

The OIG declined to remark.

Former Justice Division officers informed KHN that repeat violators are savvy and discover methods to avoid the system. KHN examined a pattern of 300 well being care enterprise house owners and executives who’re amongst greater than 1,600 on the OIG’s exclusion listing since January 2017. Journalists reviewed courtroom and property data, social media, and different publicly out there paperwork.

KHN discovered:

• Eight individuals seemed to be serving or served in roles that would violate their bans;
• Six transferred management of a enterprise to household or family members;
• 9 had earlier, unrelated felony or fraud convictions, and went on to defraud the well being care system;
• And 7 had been repeat violators, a few of whom raked in tens of thousands and thousands of federal well being care {dollars} earlier than getting caught by officers after a previous exclusion.

Doggett’s invoice is “a fairly good step in the best path in fixing this problem,” stated John Kelly, a former assistant chief of well being care fraud on the Division of Justice who’s now a associate for the legislation agency Barnes & Thornburg. Kelly had beforehand really useful that NPIs needs to be “basically cleaned” when an individual is on the exclusions listing.

Kelly, who confirmed that Doggett’s workplace reached out to him after KHN’s investigation was printed in December, stated taking the NPI quantity away “definitely doesn’t eradicate all threat” however it’s a transfer “in the best path.”

“If you wish to invoice Medicare, you need to have a legitimate NPI,” Kelly stated.