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The PRIME Act
[By Carol Miller RN MBA PMP]
First there was Amazon PRIME; now there is another PRIME.
The Act
This Act was introduced into congress in 2013 and contains a number of provisions that would increase rewards and incentives for those who uncover healthcare fraud, as well as heighten penalties for those who commit it.
What it is
The PRIME Act would enact stronger penalties for Medicare and Medicaid fraud; curb improper or mistaken payments made by Medicare and Medicaid; establish stronger fraud and waste prevention strategies with Medicare and Medicaid to help phase out the practice of “pay and chase” (i.e., recouping monies already erroneously paid to providers instead of detecting problems on the front end); curb the theft of physician identities; expand the fraud identification and reporting work of the Senior Medicare patrol; take steps to help states identify and prevent Medicaid overpayments; and improve the sharing of fraud data across state and federal agencies and programs.
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HIPAA
The law directs the Secretary to develop a plan to revise the incentive program under HIPAA for the reporting of fraud and abuse to encourage greater participation by individuals reporting Medicare fraud and abuse.
Assessment
The law also requires the plan to include certain recommendations for ways to enhance rewards for individuals reporting and an extension of the incentive program to the Medicaid program.
Conclusion
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ABOUT
Ms. Carol S. Miller has an extensive healthcare background in operations, business development and capture in both the public and private sector. Over the last 10 years she has provided management support to projects in the Department of Health and Human Services, Veterans Affairs, and Department of Defense medical programs. In most recent years, Carol has served as Vice President and Senior Account Executive for NCI Information Systems, Inc., Assistant Vice President at SAIC, and Program Manager at MITRE. She has led the successful capture of large IDIQ/GWAC programs, managed the operations of multiple government contracts, interacted with many government key executives, and increased the new account portfolios for each firm she supported. She earned her MBA from Marymount University; BS in Business from Saint Joseph’s College, and BS in Nursing from the University of Pittsburgh. She is a Certified PMI Project Management Professional (PMP) (PMI PMP) and a Certified HIPAA Professional (CHP), with Top Secret Security clearance issued by the DoD in 2006. Ms. Miller is also a HIMSS Fellow.
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OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:
- PRACTICES: www.BusinessofMedicalPractice.com
- HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
- CLINICS: http://www.crcpress.com/product/isbn/9781439879900
- ADVISORS: www.CertifiedMedicalPlanner.org
- FINANCE: Financial Planning for Physicians and Advisors
- INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
- Dictionary of Health Economics and Finance
- Dictionary of Health Information Technology and Security
- Dictionary of Health Insurance and Managed Care
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Filed under: Health Law & Policy, Risk Management | Tagged: Carol Miller RN MBA, HIPAA, Medicare and Medicaid fraud, PRIME Act | 4 Comments »
