The recently introduced Anti-Fraud Fund Act would reportedly save $168 billion over a decade through recouped and halted fraudulent payments.
The bill, with the backing of House Budget Committee Chairman Jodey Arrington of Texas and Health Care Task Force Chairman Blake Moore of Utah, would spend $28 billion to fund the Health Care Fraud and Abuse Control Program over the next four years.
The Congressional Budget Office produced a preliminary estimate that the bill will save $168 billion, according to the committee. CBO has not published this estimate itself.
This translates to a 7-to-1 return on investment, significantly higher than past estimates, including from the Department of Health and Human Services Office of Inspector General, a component of HCFAC. Its return on investment for the program from 2017 to 2019 was calculated at 4-to-1.
The 7-to-1 figure is a forward-looking projection for additional spending, which would normally be expected to show diminishing returns relative to the program’s historical performance.
The bill invests $28 billion into the program to fund attorneys, agents and technology for HHS, the Justice Department and the Centers for Medicare & Medicaid Services to go after and prevent fraud in Medicare and Medicaid.
HCFAC’s funding, financed with money from the Medicare Hospital Insurance trust fund as well as discretionary appropriations, goes toward investigating and prosecuting healthcare fraud, recovering improper funds, investing in technology, auditing healthcare providers and independent contractors, and whistleblower compensation.
The bill also resets HCFAC’s funding baseline downward by $7 billion each year from 2028 to 2031, rather than letting the increases compound, meaning a permanent boost to the program’s baseline would require further legislative action.
Mr. Moore said this program has “proven to be one of the most effective tools to combat fraud in our healthcare system.”
He added in a statement, “I am confident that providing these immediate funds through the Anti-Fraud Fund Act over the next four years will empower [CMS Administrator Dr. Mehmet Oz’s] team to bring accountability to Medicare and Medicaid providers and ensure good stewardship of tax dollars.”
Contact the author
Please read our comment policy before commenting.