Senate Finance Committee Approves Carper Bills to Address Vulnerabilities and Strengthen Medicare and Medicaid Programs

WASHINGTON – Today, the Senate Finance Committee approved two pieces of bipartisan legislation championed by Sen. Tom Carper (D-Del.), a member of the Finance Committee and ranking member of the Homeland Security and Governmental Affairs Committee, to curb waste and fraud and improve health outcomes in Medicare and Medicaid

Earlier this year, Senators Carper and Mike Enzi (R-Wyo.), along with Representatives John Carney (D-Del.) and Peter Roskam (R-Ill.), introduced the Preventing and Reducing Improper Medicare and Medicaid Expenditures (PRIME) Act, which would implement steps to increase and enhance program integrity efforts. The bill, cosponsored by Senators Rob Portman (R-Ohio), John Thune (R-S.D.) and Mark Warner (D-Va.), addresses a set of vulnerabilities that lead to the loss of billions of dollars to waste and fraud in Medicare and Medicaid every year. The legislation would enact stronger penalties for Medicare and Medicaid fraud; establish stronger fraud and waste prevention strategies to help phase out the practice of “pay and chase”; and curb the theft of beneficiary identities. Most of the provisions are based on the findings and recommendations of the Government Accountability Office, the Health and Human Services Inspector General, and other experts and stakeholders.

“Medicare and Medicaid are two of our nation’s most critical safety-net programs that millions of our most vulnerable Americans – the poor, the elderly, and the disabled – rely on every day for quality health care,” Sen. Carper said. “But every year, these programs lose billions of dollars to waste and fraud. We in Congress have a moral obligation to ensure these programs have the resources they need to provide excellent care for beneficiaries, and at the same time, ensure that taxpayer dollars are spent responsibly and effectively. The bill takes some common sense steps to fortify the integrity of Medicare and Medicaid so that these vital programs remain solvent and yield better stewardship of our taxpayer dollars for years to come.”

Several provisions of the PRIME Act were previously included and passed as part of the “Doc Fix” legislation enacted in April of this year. Four of the remaining provisions of PRIME were approved as part of today’s Senate Finance Committee mark-up.

The Providing Programs of All Inclusive Care for the Elderly Act (PACE) Innovation Act, cosponsored by Senators Pat Toomey (R-Pa.), Bob Casey (D-Pa.), Pat Roberts (R-Kan.), Debbie Stabenow (D-Mich.), Chuck Schumer (D-N.Y.) and Mark Warner (D-Va.) and was also approved by the Finance Committee today, would allow the Centers for Medicare and Medicaid (CMS) to include PACE in demonstration programs that test how to improve health outcomes and reduce costs for seniors who are eligible for both Medicare and Medicaid. PACE provides comprehensive, fully integrated health care services to dually eligible individuals who require nursing home level care, but would like to remain in their homes. Programs like PACE are especially critical as Medicare moves from a fee-for-service system toward a prevention-based system that encourages health care providers to keep our country as healthy as possible. Due to state and federal administrative restrictions that are largely outdated, the expansion of PACE has been very slow. The PACE Innovation Act would alleviate many of these restrictions and help find ways to provide America’s seniors with higher-quality, more-efficient care.

“One of my guiding principles is to find what works and do more of it,” Sen. Carper said. “This legislation would give the Centers for Medicare and Medicaid (CMS) the flexibility it needs to do just that. We’ve begun to address the problem of rising health care costs, and programs like PACE will help us continue this important work to provide seniors with excellent care while also reducing costs. We need to do everything we can to ensure that all seniors have access to high-quality, cost-effective health care.”