Overhaul is proposed for decades-old Medicare fraud rules
WASHINGTON (AP) — The Trump administration on Wednesday proposed overhauling decades-old Medicare rules originally meant to deter fraud and abuse but now seen as a roadblock to coordinating better care for patients.
The rules under revision were intended to counter self-dealing and financial kickbacks among service providers such as hospitals, clinics and doctors.
Those regulations are now seen as an obstacle to progress because Medicare has put a premium on coordination among care providers. The complex requirements of the original rules can have a chilling effect on hospitals and doctors working together, officials say.
A major focus is to try to improve follow-up care for patients after they are discharged from hospitals, an area in which Medicare is increasingly holding hospitals accountable.
Wednesday’s announcement starts a rule-making process expected to take months. The revised regulations run to an estimated 800 pages and will be pored over by lawyers for the health care industry, which has billions of dollars at stake and has been urging changes to the rules. Patient advocates are keenly interested that consumer protections not be weakened.
Health and Human Services Secretary Alex Azar said the goal is to make the health care system more efficient, not to open the door to new types of fraud.
“We propose these changes with great appreciation for the intent of these statutes, which is preventing patients from being taken advantage of and taxpayer dollars from being misspent,” Azar said.
Officials said patients will ultimately benefit, because it should be easier to help them avoid foreseeable problems after hospitalization.
The Health and Human Services inspector general’s office is involved in rewriting one of the rules, which enforces an anti-kickback statute that it oversees.
The other major revision involves a rule that forbids clinicians from referring patients to facilities in which they have a financial interest. That rule is named after a law passed by former longtime Democratic Rep. Pete Stark of California.