Did Obamacare Contain Provisions to Reduce Health Care Fraud? – YES
General Reference (not clearly pro or con)
[Editor’s Note: The Patient Protection and Affordable Care Act includes three sections on fraud:– Sec. 6504. “Requirement to report expanded set of data elements under MMIS to detect fraud and abuse” (page 658)
– Sec. 6604. “Applicability of State law to combat fraud and abuse” (page 662)
– Sec. 10606. “Health care fraud enforcement” (page 888)
The word “fraud” or “fraudulent” appears in the law over 70 times.]
PRO (yes)
Pro
The US Department of Health and Human Services stated in its Mar. 15, 2011 fact sheet “New Tools to Fight Fraud, Strengthen Federal and Private Health Programs, and Protect Consumer and Taxpayer Dollars,” available at the Affordable Care Act website (last updated on July 26, 2012):
“The Obama Administration’s fight against health care fraud now includes a ground-breaking partnership among the federal government and several leading private and state organizations to prevent health care fraud on a national scale. To detect and prevent payment of fraudulent billings, the partnership seeks to share information and best practices. A longer-range goal is performing sophisticated analytics on a healthcare industry-wide data set that will detect and predict fraud schemes…
The Affordable Care Act takes historic steps toward combating health care fraud, waste and abuse by providing critical new tools to crack down on entities and individuals attempting to defraud Medicare, Medicaid, the Children’s Health Insurance Program (CHIP) and private insurance plans.
The Centers for Medicare & Medicaid Services (CMS) is using state-of-the-art technology review claims before they are paid to track fraud trends and flag suspect activity. New power to fight fraud, granted in the health reform law, will also help decrease the rate of improper payment claims in the traditional Medicare program.”
Pro
The National Hispanic Council on Aging (NHCOA) posted in its Apr. 5, 2012 blog entry “The Affordable Care Act Works: Winning the Fight Against Medicare Fraud,” available at its website:
“For the second year in a row, the departments’ anti-fraud activities through the Health Care Fraud Prevention and Enforcement Action Team (HEAT) have recovered more than $4 billion. This is thanks to new tools provided through the Affordable Care Act, which include:
- Tougher sentences for people who commit health care fraud
- Expanding the search for waste, fraud, and abuse to Medicaid, Medicare Advantage, and Medicare Part D programs
- Greater information-sharing capabilities between key government agencies, states, the Centers for Medicare & Medicaid Services (CMS), and law enforcement partners to suspend payments if providers and suppliers are suspected of engaging fraudulent activity.
In addition, the Affordable Care Act also directly helps Medicare beneficiaries by making it easier to detect, prevent, and report Medicare fraud themselves. The Medicare Summary Notices were recently re-designed to be more reader-friendly, which makes it easier for beneficiaries to detect and report discrepancies or errors, which could be a result of fraudulent activity.”
CON (no)
Con
[Editor’s Note: Based upon a neutral reading of the Patient Protection and Affordable Care Act and bi-partisan third party analysis, this question seems to have a clear and obvious Pro (yes) answer, and ProCon.org has therefore presented the responses in a single column with no opposing perspective.]
