Peter P. Budetti
Dr. Peter P. Budetti, a former Deputy Administrator with the Centers for Medicare and Medicaid Services, brings to his work an exceptional knowledge of government healthcare programs and Medicare and Medicaid fraud.
Known as the “anti-fraud czar,” Dr. Budetti served for three years as the first director of CMS's new Center for Program Integrity (CPI), where he enacted a major shift in CMS’s approach to dealing with Medicare and Medicaid fraud. Under his leadership, CMS shifted from its traditional “pay and chase” efforts, which were outdated and ineffective, to focus on early detection and prevention of fraud.
Dr. Budetti has substantial expertise in matters involving CMS policy, data and operations; Medicare payment issues such as Risk Adjustment, Medicare Part C, Medicare Part D, upcoding and unbundling (including Correct Coding Initiative and Medically Unlikely Edits); Medicaid funding and oversight; and a wide range of compliance and program integrity activities, requirements and contractors including Zone Program Integrity Contractors, ZPICS Recovery Audit Contractors and Medicare Administrative Contractors.
Dr. Budetti’s office at CMS designed and implemented an innovative, highly sophisticated computer system that screens every Medicare fee-for-service claim with advanced algorithms to search for fraud prior to payment. The Center for Program Integrity also constructed and put into operation a high-tech antifraud Command Center and the framework for physicians to report payments from pharmaceutical companies and others under the Physician Sunshine Act.
Prior to his appointment at CMS by President Obama, Dr. Budetti held many senior positions in government and academia that focused on medical and health issues. He served for six years as Counsel on the Subcommittee on Health and Environment, chaired by Rep. Henry A. Waxman, in the US House of Representatives. Dr. Budetti also was a staff member of the Senate Finance Committee and a core legislative drafter for President Bill Clinton's Health Security Act.
He founded and directed health policy research centers and held tenured professorships at Northwestern University and The George Washington University. He also was a faculty member of the Institute for Health Policy Studies, University of California San Francisco. For the six years prior to his appointment at CMS, Dr. Budetti was the Edward E. and Helen T. Bartlett Foundation Professor of Public Health in the University of Oklahoma’s College of Public Health. He is the author of numerous articles published in medical and public health journals.
Dr. Budetti is a board-certified pediatrician and a member of the California bar. He received his medical degree from Columbia University College of Physicians and Surgeons and his law degree from the University of California Berkeley Law (Boalt Hall).
For 12 years he served as chairman of the board of directors of Taxpayers Against Fraud, a nonprofit organization dedicated to combating fraud against the government and investors and supporting whistleblowers.
Areas of Practice
- Whistleblower/Qui Tam
- Government Agencies & Programs
- Government Contracts
- Health & Health Care Law
- Whistleblower -- Employee
- Tax Law
- Securities Law
- California, 1983
- University of California at Berkeley, Boalt Hall School of Law, Berkeley, California
- J.D. - 1977
- University of Notre Dame, Notre Dame, Indiana
- B.A. - 1966
- Major: Pre-Professional
- Waters, T.M., Parsons, J., Warnecke, R., Almagor, O., Budetti, P.P. “How Useful is the Information Provided by the National Practitioner Data Bank?” , The Joint Commission Journal on Quality and Safety, 2003; 29:416-424
- Waters, T.M., Lefevre, F., Budetti, P.P. "Medical School Attended as a Predictor of Medical Malpractice Claims" , Quality and Safety in Health Care, 2003; 12:230-236
- Waters, T.M., Studdert, D.M., Brennan, T.A., Thomas, E.J., Almagor, O., Mancewicz, M., Budetti, P.P. "Impact of the National Practitioner Data Bank on Resolution of Malpractice Claims", Inquiry, 2003; 40:283-294
- Budetti P. “10 Years Beyond the Health Security Act Failure – Subsequent Developments and Persistent Problems” , JAMA, 2004; 292:2000-2006
- Waters, T.M., Warnecke, R.B., Parsons, J., Almagor, O., Budetti, P.P. “The Role of the NPDB in the Credentialing Process”, American Journal of Medical Quality, 2006; 21:30-39
- Waters T, Budetti P, Claxton G, Lundy J. “Impact of State Tort Reforms on Physician Malpractice Payments” , Health Affairs, 2007; 26:500-509
- Agrawal S., Budetti, P. “Physician Medical Identity Theft” , JAMA 2012; 307:459-460
- Agrawal S., Brennan N., Budetti, P. The Sunshine Act – Effects on Physicians, NEnglJMed 2013; 368:2054-2057
- Agrawal S., Tarzy, B., Hunt, L., Taitsman, J., Budetti, P. Expanding Physician Education in Health Care Fraud and Program Integrity, Academic Medicine 2013 88:01-07
- The False Claims Act and Health Programs, Subcommittee on Administrative Law and Governmental Relations, Committee on the Judiciary, United States House of Representatives, April 4, 1990
- Cutting Waste, Fraud and Abuse in Medicare and Medicaid, Subcommittee on Health, Committee on Energy and Commerce, United States House of Representatives, September 22, 2010
- Fighting Fraud and Waste in Medicare and Medicaid, Committee on Appropriations, Subcommittee on Labor, Health and Human Services, Education and Related Agencies, United States Senate, February 15, 2011
- Public and Private Sector Efforts to Detect Fraud in the Health Care System, Committee on Ways and Means, Subcommittee on Oversight, United States House of Representative, March 2, 2011
- Preventing Health Care Fraud: New Tools and Approaches to Combat Old Challenges, Committee on Finance, United States Senate, March 2, 2011
- New Tools for Curbing Waste and Fraud in Medicare and Medicaid, Subcommittee on Federal Financial Management, Government Information, Federal Service, Committee on Homeland Security & Governmental Affairs, United States Senate, March 9, 2011
- Waste and Abuse in Government Health Care, Subcommittee on Health Care, District of Columbia, Census and the National Archives, Committee on Oversight and Government Reform, United States House of Representative, April 5, 2011
- Harnessing Technology and Innovation to Cut Waste and Curb Fraud in Federal Health Programs, Subcommittee on Federal Financial Management, Government Information, Federal Services, and International Security, Committee on Homeland Security & Governmental Affairs, United States Senate, July 12, 2011
- Anatomy of a Fraud Bust: From Investigation to Conviction, Committee on Finance, United States Senate, April 24, 2012
- Assessing Medicare and Medicaid Program Integrity, Subcommittee on Government Organization, Efficiency, and Financial Management, Committee on Oversight and Government Reform, June 7, 2012
- Saving Taxpayer Dollars By Curbing Waste and Fraud in Medicaid, Subcommittee on Federal Financial Management, Government Information, Federal Services, and International Security, Committee on Homeland Security and Government Affairs, United States Senate, June 14, 2012
- Fostering Innovation to Fight Waste, Fraud, and Abuse in Health Care, Committee on Energy and Commerce, Subcommittee on Health, United States House of Representatives, February 27, 2013
- Oversight and Business Practices of Durable Medical Equipment Companies, Committee on Homeland Security and Governmental Affairs, Subcommittee on Financial and Contracting Oversight, United States Senate, April 24, 2013