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Michael Petruzzelli

, National Council for Behavioral Health

Congressional Leaders Introduce Legislation to Stem Medicare Fraud

February 26, 2015 | Medicare | Uncategorized | Comments
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Legislation introduced in the House this week aims to reduce Medicare fraud and abuse and strengthen the integrity of the program. Among its many provisions, the bill would create a Part D drug management plan to prevent prescription drug abuse. In this program, beneficiaries deemed “at risk of prescription drug abuse” would only be eligible to receive and fill prescriptions from specific providers and in specific pharmacies.

The Protecting the Integrity of Medicare Act (PIMA) of 2015, introduced by Ways and Means Health Subcommittee Chairman Kevin Brady (R-TX) and Ranking Member Jim McDermott (D-WA),  does not specify how the program would determine “at risk” beneficiaries nor does it spell out how individuals would be taken off that list should they end up on it. The provision allows for stakeholder input on expedited appeals, excepted conditions, drug classes, and definitions. The bill charges the Department of Health and Human Services with finalizing and disseminating rules by January 1, 2016, with the program taking effect the following year.