SMART Health Care Act Targets Medicare Abuse & Hospital Overbilling

Rep. Spartz introduced the SMART Health Care Act designed to address systemic issues in Medicare and Medicaid, aiming to reduce waste and abuse by large insurers and hospitals.

The act targets Medicare Advantage overbilling, where insurers allegedly inflate patient risk profiles to claim higher payments, proposing to extend risk adjustment to two years of data. It also tackles hospital overbilling practices, especially facility fees charged after hospital acquisitions of physician practices, which contribute to higher healthcare costs and physician consolidation.

Current regulations limiting physician ownership of hospitals in rural areas are proposed to be lifted to enhance care access. The legislation demands transparency and fairness in the 340B drug discount program, aiming to prevent providers from overcharging patients.

Lastly, the bill seeks tighter Medicare payments to poorly performing skilled nursing facilities, increasing penalties to incentivize better management. These measures reflect efforts to improve Medicare and Medicaid fiscal health, promote provider accountability, and enhance care quality, particularly in underserved rural communities.