​How the PRIME Act Impacts Providers

The Advisory Board’s GC Agenda

Arthur J. Fried, Member of the Firm, and Benjamin M. Zegarelli, Associate, in the Health Care and Life Sciences practice, in the firm’s New York office, authored an article in The Advisory Board’s GC Agenda, titled “How the PRIME Act Impacts Providers.”

Following is an excerpt (see below for a PDF of the full version):

On April 16, 2015, the Medicare Access and CHIP Reauthorization Act (Public Law 114-010), which repealed the Medicare sustainable growth rate, improved Medicare payments for physicians, and extended the Children’s Health Insurance Program by 2 years, became law. The Medicare Access Act also incorporated amendments to the Social Security Act originally proposed in the Preventing and Reducing Improper Medicare and Medicaid Expenditures (PRIME) Act. A bipartisan group of U.S. Senators had reintroduced the PRIME Act in March 2015, following the lead of the U.S. House of Representatives, which tapped the bill for reconsideration in February. The initiatives proposed in the PRIME Act, and subsequently enacted in the Medicare Access Act, stiffen protections against Medicare and Medicaid fraud and abuse and to increase fraud detection measures. At the same time, however, the relevant provisions place heightened requirements and restrictions on health care entities, increasing regulatory pressure on those who provide care to Medicare and Medicaid beneficiaries.