The House voted Thursday to avoid a nearly 24 percent cut to the reimbursement rates that Medicare pays to doctors, just days before a critical April 1 deadline.

The so-called “Doc Fix” will cost approximately $20 billion, but it’s just the latest in a long run of band-aids Congress has applied to the complex formula that is used to determine Medicare reimbursement rates. The cost is being covered through an accounting sleight-of-hand, by slightly moving up automatic cuts to Medicare that were part of so-called sequestration. The Senate is expected to take up the legislation soon, possibly the same day. Temporary patches to the reimbursement formula have now cost more than $150 billion over the last decade, the Washington Post reports.

Some Republicans, whose leaders pushed through the legislation by using an unusual procedure known as a voice vote, decried the accounting maneuvers used to offset the cost.

“It’s just another form of fake money we have around here,” Rep. John Fleming (R-La.) said of the vote. Fleming was off the House floor during the voice vote, but said he would have voted against the legislation. “Basically, the question was: do we let it lapse and have across-the-board cuts, or do we pass this one year patch?” Fleming said. “We didn’t want to vote for it, and we didn’t want to vote against it.”

A voice vote is one method the majority party can use to push through controversial legislation. It requires the acting Speaker to decide that verbal yes votes outnumber votes in opposition. Individual lawmakers’ votes aren’t tallied during a voice vote, making it easier to pass politically charged legislation. Democrats and Republicans agreed beforehand to not ask for a recorded vote, even though members of both parties have opposed a temporary Medicare fix. The decision to hold a voice vote appeared to be a closely kept secret until the last minute—one junior Republican member didn’t hear about the vote until after it already happened, and Fleming said there were less than 100 members on the floor.

“Oh, that was a voice [vote],” Rep. James Lankford (R-Okla.), a member of the GOP leadership team, said when asked how he voted. “I wasn’t even on the floor.”

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