PCORI Offers Funding to Develop Research Network
On April 23, the Patient-Centered Outcomes Research Institute (“PCORI”) announced funding up to $68 million in efforts to build a research network to support comparative effectiveness studies.
Up to $56 million is available for eight new or existing clinical data research networks that must have the participation of at least two health care systems and be able to involve more than one million patients by the end of the 18-month award period. The institute is offering up to $12 million for as many as 18 new or existing patient-powered research networks. Those networks should have the ability to enroll at least 50 patients for studies involving the rarest conditions and 10,000 for more common ones.
Letters of intent are due June 19, and applications are due by September 27. PCORI plans to award the grants in December of this year.
CMS Proposes Bigger Rewards for Fraud Tipsters Using IRS Model
On April 24, CMS released a proposed rule allowing those who successfully tip off the government to fraudulent Medicare schemes to receive up to 15% of the amount recovered for the first $66 million. Current rules allow tipsters to receive 10% of any award. In 1998, CMS began paying for tips leading to fraud recovery; since then, only 18 rewards have been paid for less than $16,000.
The proposed rule also allows CMS to deny enrollment if the provider, supplier or owner applying to be part of Medicare was the owner of another provider or supplier that had Medicare debt, if the Medicare debt has not been fully repaid and if CMS determines the uncollected debt poses a risk for waste and fraud. The rule would also allow for denial of enrollment or revocation of billing privileges if the supplier or owner had a previous felony conviction.
CMS Letter Discusses Pay for Performance on ACOs
On April 23, CMS sent a letter to the 32 Pioneer ACOs restating the federal government will pay the ACOs based on their performance this year. The CMS letter was in response to a February letter from several of the Pioneer ACOs asking CMS to make 2013 another year in which ACOs are required to only report data rather than having reimbursement tied to their performance. The ACO letter argued that, through delay, CMS would then have enough data to set performance benchmarks for 2014.
Richard Gilfillan, director of the Center for Medicare and Medicaid Innovation, responded in the CMS letter that because of the significant money being dedicated to Pioneer ACOs, they would be paid for performance on schedule this year.
Senate Report Offers Details on Fraud-Fighting Recommendations
On April 25, a bipartisan group of Senate Finance Committee members released a report providing an analysis of industry recommendations for fighting Medicare and Medicaid fraud. This is the second report the committee has released in 2013 focusing on fighting fraud.
In January of this year, the committee released the original set of recommendations gathered from stakeholder comments. The Finance Committee originally solicited industry recommendations to fight Medicare fraud in May 2012. Among the policy reform recommendations, industry white papers called on Congress to consider offering incentives to providers for encouraging investments in anti-fraud technology.
Bills Introduced This Week
S. 842: On April 25, Sen. Chuck Schumer (D-NY) introduced legislation that would amend Title XVIII of the Social Security Act to provide an extension of the Medicare-dependent hospital program. The bill would also increase payments under the Medicare low-volume hospital program. The bill was referred to the Senate Finance committee.
H.R. 1661: On April 19, Rep. Steve Israel (D-NY) introduced legislation amending Title XVIII of the Social Security Act to provide comprehensive cancer patient treatment education under Medicare. The bill would also provide for research to improve cancer symptom management.
H.R. 1713: On April 24, Rep. Tim Murphy (R-PA) introduced a bill that would establish a procedure to safeguard the surpluses of the Social Security and Medicare hospital insurance trust funds.
For more information, please contact John F. Williams, III at 317-977-1462 or jwilliams@hallrender.com.
Please visit the Hall Render Blog at http://blogs.hallrender.com/ for more information on topics related to health care law.
