North Indy News

Rep. Spartz has introduced new legislation aimed at addressing issues within the Medicare and Medicaid systems. The proposed SMART Health Care Act seeks to tackle what Spartz describes as "Medicare waste and abuse" that has been exploited by large organizations for too long.

Spartz emphasized the need for Congress to act decisively, stating, “Congress needs to grow a backbone for a change and start remembering who we serve.” She highlighted the importance of stopping money-laundering in Medicare and Medicaid to safeguard both health care and the nation's fiscal future.

The SMART Health Care Act comprises five key components:

1. It addresses overbilling in Medicare Advantage by large insurers. Investigations have revealed that some insurers manipulate the system to make patients appear sicker than they are, costing taxpayers billions. The bill proposes expanding risk-adjustment data from one year to two years to better assess beneficiary risk.

2. The bill aims to halt overbilling practices by large hospitals, which contribute significantly to rising health care costs. Hospitals often acquire independent physician practices and charge higher fees for services at these locations. This practice leads to increased provider consolidation and higher prices for patients.

3. To improve access to care in rural areas, the bill lifts restrictions on physician-owned hospitals providing services to Medicare and Medicaid patients.

4. It requires 340B providers not to upcharge patients for prescription drugs, addressing concerns about program oversight and transparency.

5. The bill seeks to enhance quality of care at skilled nursing facilities by increasing potential Medicare payment reductions for poorly managed facilities from 2% up to 5%.

Spartz also recently introduced a legislative package targeting hospital monopolies, including measures aimed at increasing transparency regarding community benefits provided by tax-exempt hospitals.