Health Care Providers Should Be Aware of New Medicare Law Changes

Thursday, January 14, 2016
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

President Obama executed a new law on December 28, 2015, which will significantly impact Medicare.  The recently enacted law, the Patient Access and Medicare Protection Act, includes a number of Medicare provisions not included in the Consolidated Appropriations Act.  The Act amended several parallel sections of the Social Security Act (SSA) and the United States Code pertaining to Medicare including, in part: payments for certain complex rehabilitation technology and radiation therapy services, flexibility in applying a hardship exception from meaningful use of electronic health records, and improvements to Medicare and Medicaid program integrity.  To read the press release issued by the Press Secretary of The White House, click here

While the Act encompasses eight various Medicare reforms, I have outlined the three most relevant provisions for all providers below.  

For a complete history of the bill, click here

Adjustment of Award Fees as Error Reduction Incentive.

The Act amended section 1874A(b)(1)(D) of the SSA (section 1395kk-1(b)(1)(D), 42 United States Code).  The new law provides that "the Secretary shall provide incentives for Medicare Administrative Contractors (MACs) to reduce the improper payment error rates in their jurisdictions."  In order to do so, the Act proffers incentives including a sliding scale of award fee payments and substantial reductions in award fee payments under cost-plus-award-fee contracts.  

The Secretary shall be authorized to determine additional incentives to MACs that will aid in the overall reduction of improper payment rates or to additionally devise tasks to further improve payment accuracy.  Substantial reductions will result for MACs that reach an upper end improper payment rate threshold or fail to accomplish tasks to improve payment accuracy as determined by the Secretary.  

These amendments will apply to all contracts entered into or renewed beginning three years after the date of the enactment of the Act.  For all existing contracts, the Secretary of Health and Human Services (HHS) shall seek to apply such incentives provided for in the Act by way of contract modifications. 

Strengthened Penalties for Illegal Distribution of Identification.

Section 1128B(b) of the SSA (section 1320a-7b(b), 42 United States Code) was amended by the Act with the addition of the following closing language:

    “(4) Whoever without lawful authority knowingly and willfully purchases, sells or distributes, or arranges for the purchase, sale, or distribution of a beneficiary identification number or unique health identifier for a health care provider under title XVIII, title XIX, or title XXI shall be imprisoned for not more than 10 years or fined not more than $500,000 ($1,000,000 in the case of a corporation), or both.”.

This paragraph is an inclusion to the "illegal remunerations" section of "criminal penalties for acts involving federal health care programs" under the U.S. Code. 

Improved Data Sharing Between Federal and State Programs.

This provision of the Act mandates that the Secretary of HHS shall establish a plan to encourage and facilitate the participation of states in the Medicare-Medicaid Data Match Program (Medi-Medi Program) under section 1893(g) of the SSA (section 1395ddd(g), 42 United States Code).  

On such change made to the existing law is the addition of the following clause at the end of section 1893(g)(1)(A) of the SSA (section 1395ddd(g)(1)(A), 42 United States Code):

    “(iv) furthering the Secretary’s design, development, installation, or enhancement of an automated data system architecture—
        (I) to collect, integrate, and assess data for purposes of program integrity, program oversight, and administration, including the Medi-Medi Program; and
        (II) that improves the coordination of requests for data from States.”.

Furthermore, the Secretary is charged with developing and implementing a plan to allow each relevant state agency under title XIX of the SSA, access to relevant data on improper or fraudulent payments made under the Medicare program.  

To read the full congressional Act, click here


What are your thoughts on the enactment of the Patient Access and Medicare Protection Act?  Do you think its amendments offer necessary reform and improvements, and increased integrity to the Medicare and Medicaid program?

Consult with a Health Law Attorney Experienced in Medicare and Medicaid Issues Now.

The attorneys of The Health Law Firm represent health care providers in Medicare audits, ZPIC audits and RAC audits throughout Florida and across the U.S. They also represent physicians, medical groups, nursing homes, home health agencies, pharmacies, hospitals and other healthcare providers and institutions in Medicare and Medicaid investigations, audits, recovery actions and termination from the Medicare or Medicaid Program.

For more information please visit our website at or call (407) 331-6620.


S. 2425, 114th Cong., (2015) (enacted). Web.

McCurdy, Debra A.  "Patient Access and Medicare Protection Act Signed Into Law; Includes Additional Medicare Reforms."  American Health Lawyers Association: 30 Dec. 2015.  Web.  13 Jan. 2016. 

About the Author:
George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law.  He is the President and Managing Partner of The Health Law Firm, which has a national practice.  Its main office is in the Orlando, Florida area. The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

Centers for Medicare and Medicaid Services (CMS), audit attorney, Medicare fraud defense attorney, Medicaid fraud defense attorney, Medicare Fraud Strike Force, Medicare Administrative Contractors (MACs) attorney, Zone Program Integrity Contractor (ZPIC) audit lawyer, Recovery Audit Contractor (RAC) lawyer, health law defense attorney, Medicare defense lawyer, Florida health attorney, Patient Access and Medicare Protection Act, health law attorney, Florida health lawyer, The Health Law Firm, health law defense lawyer, health professional attorney, incentives to reduce improper payment error rates,  Medicare-Medicaid Data Match Program (Medi-Medi Program)

“The Health Law Firm” is a registered fictitious business name of George F. Indest III, P.A. – The Health Law Firm, a Florida professional service corporation, since 1999.

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