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Brady and McDermott Introduce Bill to Prevent Medicare Fraud

February 24, 2015

WASHINGTON — Today, Ways and Means Health Subcommittee Chairman Kevin Brady (R-TX) and Ranking Member Jim McDermott (D-WA) introduced H.R. 1021, the Protecting the Integrity of Medicare Act (PIMA) of 2015. The bill would prevent fraud in Medicare by making a number of commonsense reforms such as removing Social Security numbers from Medicare cards and eliminating unnecessary paperwork for employers. PIMA incorporates a number of ideas from legislation previously introduced by committee members from both parties.

In introducing the legislation, Chairman Brady said:

“We have all heard stories and read the news regarding fraud, waste, and abuse in the Medicare program. Seniors are either personally harmed or negatively affected by the rising costs in health care due to these all-too-common activities. I am pleased to re-introduce the Protecting the Integrity of Medicare Act, a bipartisan piece of legislation that will reduce fraud, waste, and abuse within Medicare. By increasing education, transparency, and communication between Medicare’s payers and the providers that treat our seniors, in addition to commonsense proposals such as removing Social Security numbers from Medicare cards, the members of this subcommittee are tackling these issues head on. Our seniors deserve better, and I am proud to re-introduce this bill with my friend and colleague on the Ways and Means Committee, Dr. McDermott.”

In introducing the legislation, Ranking Member McDermott said:

“I thank Chairman Brady for working collaboratively on the Protecting the Integrity of Medicare Act. This bill combines a number of bipartisan proposals that make positive changes to our program integrity laws. Moving forward, the American people deserve additional reforms that modernize outdated laws and advance the ball further in the fight against wrongdoers who engage in fraud, waste, and abuse. I intend to continue working with my colleagues in the Congress to improve and strengthen the integrity of our federal health programs.”

PIMA would take a number of steps to protect seniors and the Medicare program:

  • Remove Social Security numbers from Medicare beneficiary cards. This provision is based on legislation introduced by Rep. Sam Johnson and Rep. Lloyd Doggett in each of the last three Congresses. (H.R. 380)

  • Increase outreach and education for providers by Medicare contractors and other program integrity efforts in the PRIME Act, legislation sponsored by Rep. Peter Roskam and Rep. Earl Blumenauer. (H.R. 818)

  • Expand who can document the face-to-face encounter required for Medicare durable medical equipment prescriptions to include nurse practitioners and physician assistants, as allowed by state law. This provision is based on legislation introduced previously by Rep. Jim McDermott.

  • Provide existing beneficiaries the option to receive a Medicare summary notice (MSN) electronically beginning in 2015 and Medicare Administrative Contractor efficiency measures in accordance with a bill introduced by Rep. Jim Renacci and by Rep. Bill Pascrell. (H.R. 289)

  • Require that the HHS Secretary issue guidance on the application of the “Common Rule,” which provides protection for individuals involved in research by incorporating legislation introduced by Rep. Bill Pascrell and Rep. Charles Boustany. (H.R. 965)

  • Require the HHS Secretary to issue a report describing how a permanent physician-hospital gainsharing program can best be established based on policy advocated by Rep. Charles Boustany.

  • Require changes to gainsharing restrictions to apply only to medically necessary services, allowing for the elimination of wasteful activity as previously introduced by Rep. Jim McDermott.

  • Instruct the HHS Secretary to require each home health agency to obtain a surety bond in the amount of no less than $50,000 as a condition of participation in the Medicare program based on a bill previously introduced by Rep. Jim McDermott.

  • Repeal a duplicative provision in statute causing unnecessary paperwork and burdens on employers based on a bill introduced by Rep. John Lewis and Rep. Dave Reichert. (H.R. 943)

A section-by-section of the bill can be viewed here.