Control of Congress has changed. The bipartisan appetite for scrutinizing practices across the healthcare industry has not. A new Democratic majority will arrive with no shortage of investigative priorities and only so much time to pursue them, but recent history suggests that healthcare is likely to be among them.

Affordability dominated this election cycle, and healthcare sits at the center of that debate. Combating fraud in Medicare and Medicaid has endured as a rare point of consensus precisely because it allows policymakers of both parties to say they are protecting patients and taxpayers at once. The open question is not whether that work continues, but where it is directed.

Congressional oversight largely reflects the priorities of the majority, which controls committee agendas, hearings and subpoenas. If recent history is a guide, a Democratic majority will gravitate toward a familiar set of concerns: the practices of large insurers including those involved in Medicare Advantage, the stewardship of hospital systems, the role of private equity, vertical integration across the industry, drug pricing, and the hyper-growth sectors attracting new investment.

The administration has elevated healthcare fraud to the top of its enforcement agenda. 5 billion in alleged losses, with particular emphasis on Medicaid, while CMS suspended or revoked the billing privileges of more than 2,400 providers. In an October 1 directive, DOJ’s newly created National Fraud Enforcement Division went further, designating healthcare fraud its foremost corporate enforcement priority.

Source link