Dr. Peter P. Budetti, a former Deputy Administrator with the Centers for Medicare and Medicaid Services, brings to his work with whistleblowers 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 Under his leadership, CMS shifted from its traditional “pay and chase” efforts, which were outdated and ineffective, to focus on early detection and prevention of fraud.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.
In recent years, Dr. Budetti has been writing novels to tell important stories inspired by real events, personal experiences and his imagination.
To date, he has written four novels. Resuscitated draws on his earlier life as a pediatrician, as well as his legal background and experiences in Washington and academe. Hemorrhage, Deadly Bargain and Hacked to Death form a trilogy of thrillers that grew out of his years combating fraud in healthcare.
- “The Personal Toll of Whistle-Blowing,” The New Yorker.
- “Trump includes $70M More to Fight Fraud, Prevent Overpayments,” Report on Medicare Compliance.
- “Whistleblowers fill gaps in Medicare oversight,” The Hill Extra.
- “Glitch in the Machine,” Pacific Standard.
- “Medicare Fraud Is Committed Well Beyond U.S. Borders,” Bloomberg.
- “Q&A with Peter Budetti, Of Counsel to Phillips & Cohen and Former CMS Deputy Administrator,” Bloomberg BNA.
- “Phillips & Cohen Nabs Obama’s Former ‘Anti-Fraud Czar,'” Law360.com.
- “Transparency in Medical Journals” – The New York Times
- “Stating a strong case for insurers using state whistleblower laws against fraudsters” – Journal of Insurance Fraud in America
- Federal Program Integrity Activities Following the SGR Doc Fix Legislation – CLE 3rd Annual Conference on Qui Tam: A Close Look at Healthcare Fraud & More
- Fighting Corruption and Promoting the Rule of Law as Prerequisite for Economic Development and Business Interaction – Organization for Security and Cooperation in Europe – Oct. 2016
- US-Italy Conference on Whistleblower Laws – US Embassy in Italy – Oct. 2016