Senator Chuck Grassley (R-Iowa) recently introduced the “Strengthening Program Integrity and Accountability Health Act” (S. 2964) in the Senate, which aims at curbing fraud, waste, and abuse in Medicare, Medicaid, and the Children’s Health Insurance Program. The bill includes provisions to:
- Enhance government screening of healthcare providers to keep fraudulent providers from participating in federal programs from the outset;
- Extend the amount of time government agencies have to evaluate the legitimacy of Medicare providers before payment on a claim is required when waste and abuse by the provider is suspected;
- Increase disclosure requirements by healthcare providers;
- Improve information sharing among federal agencies responsible for fighting fraud; and
- Enhance government enforcement capabilities by enlarging the range of activities subject to penalties, while also increasing existing penalties.
In addition, the bill includes amendments to the False Claims Act (FCA) to counter recent federal court decisions that reduced the FCA’s scope and applicability. For instance, the bill would amend the “original source” exception to the public disclosure bar to allow whistleblowers to proceed with an FCA case that includes allegations of fraud that were publicly disclosed if the whistleblower reported the fraud to the Government prior to the disclosure or if the whistleblower provides information to the Government that “materially adds” to the publicly disclosed allegations.