WAYS AND MEANS HEARING FOCUSES ON EFFORTS TO COMBAT FRAUD, WASTE, AND ABUSE IN MEDICARE
Congressional Desk
July 28, 2010
WASHINGTON – Ways and Means Health Subcommittee Chairman Pete Stark (D-CA) convened a joint hearing of the House Ways and Means Health and Oversight Subcommittees to examine the Administration's efforts to combat fraud, waste, and abuse in Medicare. The hearing comes one day after the Department of Health and Human Services Office of Inspector General announced an expected $3 billion in recoveries over the first six months of fiscal year 2010.
"Today's hearing gave us a clearer view of the Administration's efforts to fight fraud, waste, and abuse in Medicare," said Chairman Stark. "Health care reform gave the Administration enhanced tools to fight fraud. Our Committee will continue to support these efforts, and look for new and better ideas to fight fraud that we can enact into law."
"It is important for the Congress, the Administration, and Medicare beneficiaries to work together to combat fraud," said Oversight Chairman John Lewis (D-GA). "This hearing provided us an opportunity to discuss new, bipartisan ways to work together. Medicare fraud is a threat to the entire health care system, and I am committed to working with my colleagues to eliminate this problem."
Below are several key statements and exchanges from the hearing.
Rep. Pete Roskam (R-IL) stated that reducing Medicare fraud, waste and abuse is a bipartisan issue:
ROSKAM: "What we can do I think, is to come together as a Committee and say 'You know what? This is not about donkeys, this is not about elephants. This is not about liberals, this is not about conservatives. This is about being smart, and using the technology that is available to us, investing in it, and then deploying that to the benefits of the taxpayers and the seniors that we're here to protect.'"
Rep. Lloyd Doggett (D-TX) and Lewis Morris, Chief Counsel, Office of Inspector General, U.S. Department of Health and Human Services, discuss holding executives of companies that commit fraud accountable:
DOGGETT: "We have faced some major Medicare fraud from legitimate Fortune 500 companies that has amounted to more money being stolen from this system than from all these fly-by-night operators put together in one year. I think that is a matter for us to look at, as well as some of the ways that the Medicare system is threatened by practices that are legal."
MORRIS: "If I could just offer one thought to that effect, we've considered how to change the approach that corporate America takes to the integrity of our system. We think that one of the challenges we need to address is having executives understand that they will be held personally accountable for schemes that are then hatched and pushed downstream. To that end, we've offered some technical assistance that would allow us to exclude from the Medicare and Medicaid programs managing employees that are behind these schemes. Although there are challenges to building a criminal case against a high-level executive -- there's a lot of plausible deniability built into these large companies -- it's an area where we and our partners at the Department of Justice are focusing on, because we recognize that the way we are going to change corporate cultures is by focusing on individuals. I think you're going to see in the coming months through our efforts and our partners at the Department of Justice different approaches so that Fortune 500 companies understand that they will be treated the same way as anyone else who abuses our program."
DOGGETT: "Well that's extremely important and I salute your efforts. And as you do it, if you find any ways that we need to change the laws to facilitate your efforts, I think that many of us would like to do that."
Rep. Xavier Becerra (D-CA) and Edward N. Siskel, Associate Deputy Attorney General, U.S. Department of Justice, Chicago, Illinois, discuss how fraudsters prey on vulnerable populations:
BECERRA: "What we're finding the more you all gather this data and get it to us, is not so much that fraudsters are targeting the Medicare program or the Medicaid program, as opposed to a private insurance program. It's that they're targeting seniors, older folks, and the poor, or those who are less sophisticated and educated about how to defend themselves against the abuse and the fraud."
SISKEL: "The fraudsters don't distinguish between public and private programs. They're willing to steal from anyone. So we have to go after the fraud wherever it occurs... these fraudsters are willing to go after our most vulnerable population, and that's why we are so committed to going after them wherever it takes place, in whatever program or private sector provider they're preying on."
Chairman Pete Stark (D-CA) asks Lewis Morris about the benefits of using health IT to combat fraud:
STARK: "If we had a more universal information technology program in place, would it help in your efforts?"
MORRIS: "I think that is one of the things we're striving for, is to have a set of standards that would allow doctors, hospitals, and suppliers all to use the same media to exchange information. It would improve efficiencies, it would improve accuracy, you wouldn't have to worry about whether a physician's script was misread and that the wrong drug was provided. I think it would also help us in the fight against fraud and abuse. It would give us a large amount of data which we then could data-mine to identify aberrant practices and outliers. So I think the short answer is having a unified electronic health record is powerful."
Lewis Morris discusses the importance of having providers cooperate with efforts to combat abuse:
MORRIS: "We need the provider community to understand that embracing compliance measures; doing internal efforts to ensure that the claims are going out correctly; that their billing people are properly educated; that they take responsibility for bringing overpayments back to our program; is part of their obligation to be a good partner with us."
For more information on the hearing, please visit: http://go.usa.gov/3w9
"Today's hearing gave us a clearer view of the Administration's efforts to fight fraud, waste, and abuse in Medicare," said Chairman Stark. "Health care reform gave the Administration enhanced tools to fight fraud. Our Committee will continue to support these efforts, and look for new and better ideas to fight fraud that we can enact into law."
"It is important for the Congress, the Administration, and Medicare beneficiaries to work together to combat fraud," said Oversight Chairman John Lewis (D-GA). "This hearing provided us an opportunity to discuss new, bipartisan ways to work together. Medicare fraud is a threat to the entire health care system, and I am committed to working with my colleagues to eliminate this problem."
Below are several key statements and exchanges from the hearing.
Rep. Pete Roskam (R-IL) stated that reducing Medicare fraud, waste and abuse is a bipartisan issue:
ROSKAM: "What we can do I think, is to come together as a Committee and say 'You know what? This is not about donkeys, this is not about elephants. This is not about liberals, this is not about conservatives. This is about being smart, and using the technology that is available to us, investing in it, and then deploying that to the benefits of the taxpayers and the seniors that we're here to protect.'"
Rep. Lloyd Doggett (D-TX) and Lewis Morris, Chief Counsel, Office of Inspector General, U.S. Department of Health and Human Services, discuss holding executives of companies that commit fraud accountable:
DOGGETT: "We have faced some major Medicare fraud from legitimate Fortune 500 companies that has amounted to more money being stolen from this system than from all these fly-by-night operators put together in one year. I think that is a matter for us to look at, as well as some of the ways that the Medicare system is threatened by practices that are legal."
MORRIS: "If I could just offer one thought to that effect, we've considered how to change the approach that corporate America takes to the integrity of our system. We think that one of the challenges we need to address is having executives understand that they will be held personally accountable for schemes that are then hatched and pushed downstream. To that end, we've offered some technical assistance that would allow us to exclude from the Medicare and Medicaid programs managing employees that are behind these schemes. Although there are challenges to building a criminal case against a high-level executive -- there's a lot of plausible deniability built into these large companies -- it's an area where we and our partners at the Department of Justice are focusing on, because we recognize that the way we are going to change corporate cultures is by focusing on individuals. I think you're going to see in the coming months through our efforts and our partners at the Department of Justice different approaches so that Fortune 500 companies understand that they will be treated the same way as anyone else who abuses our program."
DOGGETT: "Well that's extremely important and I salute your efforts. And as you do it, if you find any ways that we need to change the laws to facilitate your efforts, I think that many of us would like to do that."
Rep. Xavier Becerra (D-CA) and Edward N. Siskel, Associate Deputy Attorney General, U.S. Department of Justice, Chicago, Illinois, discuss how fraudsters prey on vulnerable populations:
BECERRA: "What we're finding the more you all gather this data and get it to us, is not so much that fraudsters are targeting the Medicare program or the Medicaid program, as opposed to a private insurance program. It's that they're targeting seniors, older folks, and the poor, or those who are less sophisticated and educated about how to defend themselves against the abuse and the fraud."
SISKEL: "The fraudsters don't distinguish between public and private programs. They're willing to steal from anyone. So we have to go after the fraud wherever it occurs... these fraudsters are willing to go after our most vulnerable population, and that's why we are so committed to going after them wherever it takes place, in whatever program or private sector provider they're preying on."
Chairman Pete Stark (D-CA) asks Lewis Morris about the benefits of using health IT to combat fraud:
STARK: "If we had a more universal information technology program in place, would it help in your efforts?"
MORRIS: "I think that is one of the things we're striving for, is to have a set of standards that would allow doctors, hospitals, and suppliers all to use the same media to exchange information. It would improve efficiencies, it would improve accuracy, you wouldn't have to worry about whether a physician's script was misread and that the wrong drug was provided. I think it would also help us in the fight against fraud and abuse. It would give us a large amount of data which we then could data-mine to identify aberrant practices and outliers. So I think the short answer is having a unified electronic health record is powerful."
Lewis Morris discusses the importance of having providers cooperate with efforts to combat abuse:
MORRIS: "We need the provider community to understand that embracing compliance measures; doing internal efforts to ensure that the claims are going out correctly; that their billing people are properly educated; that they take responsibility for bringing overpayments back to our program; is part of their obligation to be a good partner with us."
For more information on the hearing, please visit: http://go.usa.gov/3w9
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