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From Health Law Daily, December 10, 2014

Fraud and abuse funding doubled in 2015 omnibus bill

By Jay Nawrocki, M.A.

The amount of money available for fraud and abuse investigations in fiscal year (FY) 2015 was more than doubled in the provisions of the Consolidated and Continuing Appropriations Act, 2015 that will be considered by Congress between December 10 and December 15, 2014. The legislation provides $1.01 trillion to fund the federal government for 2015. The legislation also provides additional funding for community health centers (CHC) in addition to the amount required by the Patient Protections and Affordable Care Act (ACA) (P.L. 111-148). With certain exceptions, health plans that provide coverage to expatriates of the U.S. and individuals from foreign countries working in the United States are exempted from the provisions of the ACA and not considered a U.S. health risk. Finally, significant additional funding is provided to the Veterans Administration (VA) to improve the delivery of care.

Fraud and abuse funding. In FY 2015, $672 million will be available for operations of the Health Care Fraud and Abuse Program (HCFAC). This is more than double the amount appropriated for this purpose in FY 2014. Justification for this dramatic increase was provided in a summary of the legislation prepared by the Senate’s Committee on Appropriation. “The latest data demonstrates that for $1 spent on fraud and abuse control, $8.10 is recovered by the Department of the Treasury,” according to the summary. It was estimated that this spending will result in a $5.4 billion savings.

Medicare and Medicaid. In FY 2015, $234.6 billion is appropriated for the federal share of Medicaid payments, and $259.2 billion is appropriated to the Federal Hospital Insurance Trust Fund and the Federal Supplemental Medical Insurance Trust Fund for Medicare expenditures. The legislation included $265 million for Children’s Hospitals Graduate Medical Education (CHGME) costs. This is the same amount that was provided in FY 2014. The administration had recommended the removal of all funding for CHGME.

For discretionary budget items, $156.76 billion was appropriated to the Departments of Labor, HHS, and Education. This is $10 million less than was appropriated in FY 2014. The Labor, HHS, and Education spending in the legislation makes up the largest share, 32 percent, of non-defense discretionary spending for FY 2015.

ACA changes. The legislation also included $1.492 billion for CHCs which is an increase of $1.452 billion from FY 2014 and in addition to the $5.092 billion authorized by the ACA. CHCs are located in areas where there is a shortage of available health professionals, called health professional shortage areas, and intended to serve medically underserved populations, such as migrant farmworkers, the homeless, or residents of public housing.

Expatriate health plans have been exempted from the ACA. An expatriate health plan is a plan that provides coverage to individuals that have moved to the United States for a specific and temporary purpose or assignment related to their employment, or individuals who are working outside of the United States for a period of at least 180 days in a consecutive 12 month period that overlaps with a plan year. Individuals enrolled in health plans for expatriates are not to be considered a health risk for the United States.

VA funding. The VA is receiving $2.5 billion for expedited claims processing, which included $40 million more than was requested. The additional $40 million is to be used to hire additional claim and support personnel in regional offices, and to expand the Veterans Claims Intake Program record scanning system. The legislation includes $5 million to address a backlog of the appeals of claims. The Rural Health Initiative received $250 million to provide telehealth and mobile clinics for veterans in rural areas where approximately 36 percent of veterans live. The legislation also provides $7.04 billion for institutional and home-based long term care programs for veterans.

The House is expected to approve the legislation on Thursday December 11, 2014 and Senate approval is expected no sooner than Friday December 12, 2014 or most likely early in the following week, according to The Hill. A stop-gap measure will keep the government funding while Congress debates and approves the omnibus bill.

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