Republican Rep. Gabe Evans of Colorado is championing a bipartisan effort to close a critical loophole within Medicare and Medicaid, aiming to curb identity theft that currently plagues these vital healthcare programs.
Evans’ initiative focuses on ensuring that deceased physicians’ identification numbers are not misused for fraudulent billing. According to his proposed bill, states would be mandated to regularly cross-reference social security records with Medicaid and Medicare provider databases. This measure targets the misuse of provider identities to illicitly obtain payments from the federal programs.
“Preventing that identity theft from being weaponized in the Medicaid space by removing providers who have passed on from the system and taking that provider number out of system as a viable method to get payment,” Evans stated, “is step one in how we reduce these instances of what amounts to identity theft of a provider.”
Evans, who has personal experience of the impact of healthcare challenges due to his son’s medical needs, emphasized his commitment to safeguarding these federal health programs for those who rely on them.
Concerns over improper payments in these programs have been highlighted by the Government Accountability Office, estimating $54 billion in erroneous Medicare payments and an additional $31 billion for Medicaid last year. Recent audits, including one probing the Colorado Department of Health Care Policy and Financing, which manages Medicaid, have also revealed issues like missing eligibility documentation and inaccurate procedure codes in billing. The department has stated that most of these issues had minimal financial implications and impacted a small fraction of processed claims.
The Colorado Department of Health Care Policy and Financing released a statement affirming their commitment to responsible fiscal management, stating, “The Department of Health Care Policy and Financing is committed to ensuring responsible use of taxpayer dollars to get Coloradans the care they qualify for and need to thrive, and we continue to implement changes and improvements to ensure this.”
This legislative action from Evans comes as Congress debates potential spending cuts. The U.S. Senate is evaluating a measure that would require the House Energy and Commerce Committee—on which Evans serves—to reduce spending by $880 billion. Medicaid, a program overseen by this committee, faces potential impacts from these proposed cuts. According to the Colorado Department of Health Care Policy and Financing, these reductions could lead to hundreds of thousands of Coloradans losing their health coverage.
