The Clinton administration's fiscal 2000 budget will contain a package of measures designed to reduce healthcare fraud, including giving broader authority for HCFA to terminate private anti-fraud units that are underperforming, administration officials said last week.
Administration sources also said adding a Medicare prescription drug benefit is a possibility, but cost and the short amount of time before the budget's February release make it a long shot.
"We are concerned about prescription drugs; it's a huge hole in the Medicare benefit," said a White House aide who confirmed the drug benefit was being considered. "But it is a significant financial challenge, and there are no easy answers. No decisions have been made."
The inclusion of a prescription benefit would be a political coup for the administration. It would pre-empt the National Bipartisan Commission on the Future of Medicare, which also might recommend adding a drug benefit in its report scheduled for release next March. By beating the commission to the punch, the White House could claim the initiative as its own.
The cost of such a benefit is staggering. One limited plan being considered by the commission, which would include a 20% beneficiary co-insurance and a $1,000 deductible, would cost Medicare an estimated $69 billion over five years.
Provider user fees also are slated to make a return engagement in fiscal 2000, which begins Oct. 1, 1999.
Nearly $700 million in provider user fees were proposed by the Clinton administration last year to pay for a variety of HCFA administrative functions. About $400 million of that would have been collected from hospitals and other Medicare Part A providers to pay for more provider audits. However, under pressure from provider groups, Congress rejected the fees.
No details of the administration's user-fee proposal for 2000 were available.
"We're disappointed that after Congress clearly rejected user fees last year the (Clinton) administration insists on trying again," said Thomas Nickels, vice president and deputy director of federal relations at the American Hospital Association.
The new anti-fraud initiative comes a week after HHS' inspector general's office released a report criticizing many anti-fraud units operated by Medicare fiscal intermediaries for finding few, if any, fraud cases (Dec. 7, p. 12).
Under the administration's proposal, the fraud units would have to report all fraud complaints to the inspector general regardless of size or scope.
Much of the anti-fraud proposal was included in last year's budget. President Clinton also called on HCFA to create a comprehensive anti-fraud strategy, which a HCFA spokesman said is already in the works.