Department of Health and Human Services

Require 90 day review for 1st time Medicare/Medicaid Providers

Billions of dollars in fraud are committed by "Strip mall" and other clinics that are established, take in patients, then pad billing statements. Congress, thinking it was doing a good thing years ago, mandated providers be paid within 30 days. The law of unintended consequences meant that criminals set up shop, did millions and millions in false billings, and then ran off before they were investigated and arrested. They were then able to move on and start again, often in the same state. This cycle can be stopped by requiring a sliding scale approval process. E.g., if a provider has been working with Medicare / Medicaid for several years, then they will be paid within 30 days. A new provider, within 90 days, and only up to a maximum of X dollars for the first few months. Again, go with a sliding scale. In addition, those businesses that wish to handle Medicare and Medicaid should be required to register with photos, fingerprints, pass, business licensing information, etc, and have a background check required for them to own or operate the faciilty. The ownership information will be provided to each state's board of medical examiners and any provider who bills Medicare / Medicaid more than $50,000/year should also be required to register with license information and a photo, copy of drivers and medical license, etc.. The information should be shared wtih Medicare and Medicaid as a means of tracking the bad apples that prey upon the taxpayer and patients alike. Comments welcome.



Idea No. 1291