Congressional Doctors Advocate Medicare, PBM Reforms to Curb Fraud and Costs

Two members of the House GOP Doctors Caucus, Congressman Greg Murphy, M.D., and Congressman Mike Kennedy, M.D., outlined key reforms necessary to address inefficiencies and fraud within the Medicare program and broader healthcare delivery system. They highlighted Medicare Advantage as vulnerable to fraudulent exploitation, where some organizations manipulate patient data to bill Medicare for higher costs than warranted. This misuse leads to hundreds of billions in losses for the government.

Additionally, they focused on the impact of graduate medical education (GME) funding through Medicare, which contributes to Medicare's financial instability. Congressman Kennedy emphasized the need to reconsider the extent of government involvement in medical practice regulation and funding, suggesting that reducing governmental constraints could foster a more sustainable system.

Both legislators stressed the critical role of pharmacy benefit managers (PBMs) in driving up drug costs, citing the need for targeted PBM reform to control medication prices effectively. Medicare Advantage program reform and physician fee schedule adjustments were also identified as bipartisan legislative priorities to improve healthcare cost management and system efficiency. The discussion underscores broader concerns over Medicare's solvency, healthcare fraud, and regulatory complexity, signaling areas for potential reform to ensure long-term sustainability of healthcare financing.