Health Policy

Respond to Yolanda Health Policy The policy I selected is bill H. R. 4401, the Protecting Seniors Health Care Fraud Act. Medicare fraud, waste, and abuse can take many forms, but in some cases, this results in some form of monetary loss (Bauder & Khoshgoftaar, 2020). According to (Congress.gov) "in connection with the Health Care Fraud and Abuse Control Program established under section 1128C, the Secretary, acting through the Office of the Inspector General of the Department of Health and Human Services, and the Attorney General shall transmit to Congress, a report regarding healthcare fraud schemes that target seniors and steps that are being taken to combat such schemes. Seniors are more vulnerable to fraud than the general population because seniors require more healthcare services than the general population" (2021). Evidence Base to Support the Proposed Policy I believe Medicare fraud amongst seniors has been an ongoing issue within healthcare organizations for years. According to (Stowell et al., 2020) some of the most significant healthcare fraud financial recoveries are related to seniors, mainly attributable to the Medicare and Medicaid programs. The evidence provided shows that through its Healthcare Fraud and Abuse Control program, the federal government won or negotiated $2.3 billion in healthcare judgments and settlements in total in 2018. $1.4 billion of which was related to Medicare and Medicaid programs. Some of the most common types of Medicare frauds are providers overcharging for services that are not medically necessary, ordering durable medical equipment and supplies that are not medically necessary. For example, providers will bill Medicare for additional laboratory and radiology services that are not aligned with the patient's current diagnosis. Another example is a provider billing Medicare for a wheelchair, and the patient is ambulatory or ordering a nebulizer machine, and the patient has no medical history of respiratory issues. According to (Stowell et al., 2020) the financial impact of senior healthcare fraud affects the patients, their families, the government, and taxpayers who pay more to cover healthcare expenditures in public health plans. References Bauder, R. A., & Khoshgoftaar, T. M. (2020). A study on rare fraud predictions with big Medicare claims fraud data. Intelligent Data Analysis, 24(1), 141-161. https://doi.org/10.3233/IDA-184415 Congress.gov (2021). H.R. 4401-Protecting Seniors from Health Care Fraud Act of 2021. https://www.congress.gov/117/bills/hr4401/BILS-117hr4401ih.xml Stowell, N. F., Pacini, C., Schmidt, M. K., & Wadlinger, N. (2020). Senior healt-hcare fraud under investigation. Journal of Financial Crime. https://doi.org/10.1108/JFC-04-2020-0071 Respond to michel S.3418 - Comprehensive Addiction Resources Emergency Act of 2021 The proposed policy primarily focuses on financially assisting, “States, territories, Tribal nations, local areas, public or private non-profit entities, and certain health providers, to provide for the development, organization, coordination, and operation of more effective and cost-efficient systems for the delivery of essential services to individuals with substance use disorder and their families” (Congress, 2022). This is important because people with substance abuse problems seeking treatment require financial support, “Medicaid expansion is particularly salient for treatment of substance use disorders, because Americans with these disorders are disproportionately unemployed and have lower incomes” (Abraham et al., 2021).