Statements On Introduced Bills And Joint Resolutions

Floor Speech

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By Mr. GRASSLEY:

S. 2964. A bill to amend title XVIII, XIX, and XXI of the Social Security Act to prevent fraud, waste, and abuse under Medicare, Medicaid, and CHIP, and for other purposes; to the Committee on Finance.

Mr. GRASSLEY. Mr. President, in 2009 the Medicare, Medicaid and CHIP programs accounted for over $800 billion of the $2.3 trillion spent on health care in the U.S. Together, these programs constitute around 35 percent of national health spending. With so much taxpayer money at stake, it is no surprise that all this spending brings crooks, scam artists and even organized crime out of the woodwork.

Low estimates are that fraudsters steal $60 billion from the Medicare and Medicaid programs every year. As Federal health care spending continues to skyrocket, so will the dollars lost to fraud, waste and abuse.

This is a crime against not only the taxpayer, but against each and every beneficiary who depends on these programs for their health care. The examples of fraud are all around us. In a 60 Minutes segment late last year, we saw a medical supply company that billed Medicare $2 million last July--despite being empty and having apparently no staff.

One man interviewed said he was waking up every day making $20,000-$40,000. Every single day. He said it was like winning the lottery, and you and me and every taxpayer were footing the bill. He was running a fake medical supply company that didn't actually sell any medical equipment to anyone. He says he stole at least $20 million from Medicare. He said it was, ``real easy.''

This must change.

I don't think Members on either side of the aisle dispute this. Back when health care reform was a bipartisan endeavor, I developed a set of legislative proposals with Senator Baucus to combat fraud, waste and abuse. These proposals are in the bill that the Finance Committee reported as well as the health care reform bill that the Senate passed late last year. And these provisions did not draw opposition from either side of the aisle. Tackling fraud, waste and abuse in health care is one of the areas where there is widespread agreement.

That is why I am here today to introduce the Strengthening Program Integrity and Accountability in Health Care Act. This legislation includes the critical measures that I developed on a bipartisan basis. This bill also includes legislation and amendments I have subsequently introduced to strengthen these proposals to address fraud, waste and abuse.

They are designed to deter, detect and prevent those that would steal from Federal health care programs, to assist those tasked with catching these criminals, and to protect taxpayer dollars. These commonsense changes will go a long way in helping to make sure Medicare, Medicaid and CHIP dollars are going to bona fide providers, instead of fraudsters set on scamming the system.

This legislation would make it harder for fraudsters to enroll in Federal health programs as providers and bilk the system. This includes requiring meaningful screening of health care providers and suppliers. Additional tools would also be provided to prevent fraud, waste and abuse including enhanced oversight measures, disclosure requirements, authority to impose enrollment moratoriums and requirements for developing compliance programs.

This bill would impose additional requirements on providers and suppliers to ensure that bona fide providers are billing Federal health programs for bona fide items and services. This includes providing documentation or performing a face-to-face evaluation before certifying a beneficiary's eligibility for an item or service.

It would also improve Federal monitoring for fraud, waste and abuse by requiring better data sharing and data access across the Federal government. Government agencies would be able to share information with each other in an effort to identify crooks in the system promptly. It would also create a national clearinghouse of information so we can better detect and prevent and thereby deter medical identity theft. Again, this is about the Federal Government sharing information it already has in ways that protect the Taxpayer and work against those defrauding the system and hopefully deter those who are thinking about stealing from you.

The legislation takes several steps to end the current ``pay and chase'' model of Federal health care spending. It takes the commonsense approach of allowing the government to withhold taxpayer dollars from those under investigation for health care fraud.

It would change Federal laws that require Medicare to pay providers quickly, regardless of the risk of fraud, waste, or abuse. Under current law, the government is required to make payment for a ``clean'' claim within 14 to 30 days before interest accrues on the claim. That is not enough time for the limited number of Medicare auditors to determine if the claim is legitimate before the payment has to be made. The result is that this ``prompt payment rule'' requires that Medicare pay fraudsters first, and ask questions later.

This requirement doesn't make any sense. This bill would give the Secretary of Health and Human Services the authority to ask questions first and then and only then to make the payment if the health care provider and the payment for services check out. The Secretary would also be required to suspend payments pending the investigation of credible allegations of fraud against the provider or supplier.

This legislation would also increase funding for those fighting health care fraud. Study after study has shown that every dollar spent fighting health care fraud is repaid multiple times over in funds recovered and fraud prevented. This is a good investment for the taxpayer and bad news for health care fraudsters.

This bill would provide powerful disincentives for those that would rob the taxpayer through health care fraud. It would better arm those fighting fraud with tools to catch and prosecute fraudsters. It also would make the consequences for committing health care fraud more meaningful by increasing civil monetary penalties and expanding the types of acts and omissions that would be subject to civil monetary penalties and exclusion from Federal health programs.

This legislation would also strengthen the government's most powerful tool for preventing and recovering taxpayer dollars lost to fraud, the False Claims Act. It also ensures that courageous whistleblowers that come forward to speak up against fraud and file False Claims Act cases are protected from retaliation by their employers.

These changes would go a long way to deter those who would defraud our health care programs. It also would provide greater protections to the taxpayer. In these difficult economic times, we have got to do everything we can to protect taxpayer dollars and the resources of health care programs on which so many Americans depend.

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