In March 2016, the Trump administration released an abridged version of their nonbinding Fiscal Year (FY) 2018 Budget Request to Congress. One of the lone bright spots for public health programs in the administration’s budget request is the recommendation of an additional $70 million for efforts to eliminate fraud and abuse at the Centers for Medicare and Medicaid Services (CMS) with an emphasis on moving away from the “pay-and-chase” model and instead preventing improper payments. According to AANEM Health Policy Director, Millie Suk, JD, MPP, “This additional funding shows that the administration takes Medicare fraud and abuse very seriously. It also indicates that the new leadership at CMS is likely to be more open to working with AANEM on creating EDX standards to help curb the fraud and abuse.” The exact text of the budget request has been included below.
Strengthens the integrity and sustainability of Medicare and Medicaid by investing in activities to prevent fraud, waste, and abuse and promote high quality and efficient health care. Additional funding for the Health Care Fraud and Abuse Control (HCFAC) program has allowed the Centers for Medicare & Medicaid Services in recent years to shift away from a “pay-and-chase” model toward identifying and preventing fraudulent or improper payments from being paid in the first place. The return on investment for the HCFAC account was $5 returned for every $1 expended from 2014-2016. The Budget proposes HCFAC discretionary funding of $751 million in 2018, which is $70 million higher than the 2017 annualized CR level.
In a subsequent hearing before House appropriators, the newly installed Secretary of the Department of Health and Human Services, Tom Price, was repeatedly questioned about the budget request. Secretary Price repeatedly affirmed the administration’s interest in better addressing fraud and abuse at CMS through novel approaches. Much of the detail of these new approaches is still being worked out and further guidance on preventing improper payments may be included when the more comprehensive FY 2018 budget request is eventually released.
The document has been dubbed a “skinny budget” since it works only in broad strokes and top line numbers. Much of the detail and specifics of the budget request are expected to be released in late April or early May.
In an effort to allocate significant additional spending to defense and military programs, the FY 2018 skinny budget calls for deep cuts to medical research and patient care programs, including a proposed cut of nearly $6 billion for the National Institutes of Health. This approach has drawn a harsh rebuke from the advocacy community as well as legislators from both sides of the aisle.