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E PL UR UM IB N U U S Congressional Record United States th of America PROCEEDINGS AND DEBATES OF THE 112 CONGRESS, FIRST SESSION Vol. 157 WASHINGTON, TUESDAY, MARCH 8, 2011 No. 34 House of Representatives The House met at 2 p.m. and was In fact, in 1990, the Government Ac- business with Medicare, and the burden called to order by the Speaker pro tem- countability Office, GAO, listed both is on the government to remove a com- pore (Mr. YODER). Medicare and Medicaid as high risk be- pany from the Medicare program. This f cause these programs are vulnerable to needs to change to allow the govern- waste, fraud, abuse, and mismanage- ment to remove bad actors from the DESIGNATION OF SPEAKER PRO ment. Now, how badly mismanaged are program quickly and efficiently. TEMPORE we talking about? Well, the GAO re- Secondly, Medicare needs to signifi- The SPEAKER pro tempore laid be- cently issued a report that there was cantly improve their provider and sup- fore the House the following commu- $48 billion just in improper payments. plier screening process. While individ- nication from the Speaker: This isn’t fraud. This is just improper uals have a right to Medicare, compa- WASHINGTON, DC, payments. So when it comes to fraud, nies do not have a right to become or March 8, 2011. it is estimated anywhere from $60 bil- stay a Medicare provider. I hereby appoint the Honorable KEVIN lion to $90 billion is lost to Medicare Third, Medicare needs to shift away YODER to act as Speaker pro tempore on this fraud every year. from a fee-for-service program. A day. During this hearing, I asked the Di- capitated managed care organization JOHN A. BOEHNER, provides a strong financial incentive to Speaker of the House of Representatives. rector of Medicare Program Integrity, whose job it is to protect Medicare the managed care organization to f eliminate fraud and abuse. It is the against fraud and abuse, if he knew managed care plan that has the finan- MORNING-HOUR DEBATE how much money is lost to fraud in cial risk and not the United States Medicare. He could not answer this The SPEAKER pro tempore. Pursu- Federal Government when criminals question. The following week, Sec- ant to the order of the House of Janu- perform fraud. Managed care organiza- ary 5, 2011, the Chair will now recog- retary Sebelius was asked in a Health tions present their own set of chal- nize Members from lists submitted by Subcommittee hearing if she knew how lenges but need to be considered when the majority and minority leaders for much money was lost to fraud in Medi- discussing reforms to eliminate fraud morning-hour debate. care. Her answer: ‘‘If we knew how big in Medicare. The Chair will alternate recognition it was, we’d hopefully shut it down.’’ And fourth, Medicare needs to in- between the parties, with each party But in my hearing, Special Agent crease the role of physicians in detect- limited to 1 hour and each Member Omar Perez, the head of the Medicare ing and preventing fraud themselves. other than the majority and minority Fraud Strike Force in the Miami re- Medicare providers and suppliers must leaders and the minority whip limited gion of Florida for the Office of the In- use a doctor’s prescription to obtain to 5 minutes each, but in no event shall spector General, testified he was able government reimbursement. Bad actors debate continue beyond 3:50 p.m. to find $3.8 billion in Medicare fraud. forge these documents. Previously, the f My colleagues, this is one city. If ex- GAO has recommended that Medicare trapolated across 50 States, with al- MEDICARE FRAUD require that physicians receive a state- most 20,000 municipalities, you can see ment of Medicare home health services The SPEAKER pro tempore. The how we could get to $60 billion to $90 that their patients receive so they can Chair recognizes the gentleman from billion in fraud. According to the In- review the documents. This will allow Florida (Mr. STEARNS) for 5 minutes. spector General, Medicare fraud is them to look at it carefully and detect Mr. STEARNS. Mr. Speaker, last more lucrative than the drug trade, any potential misuse of their author- week, as chairman of the Oversight and with easy money, less violence, and izations. Investigations Subcommittee of En- lighter punishments. And organized And lastly, Medicare needs to use ergy and Commerce, I held a hearing crime is taking notice and getting in- predictive computer modeling and on the problem of Medicare fraud. This volved in defrauding Medicare. other technologies. The credit card in- is not a new issue. It has been a con- So here are five reform ideas that dustry uses this modeling to identify tinuing problem with Medicare, and I came out of this hearing that were potentially fraudulent transactions. have been concerned about Medicare mentioned to help secure Medicare Medicare and Medicaid should adopt fraud for some time here. Last Con- against criminals engaged in defraud- this style of analysis to prevent fraud- gress, I introduced a bill to increase ing the program. ulent claims. the civil and criminal penalties on First, Medicare needs to maintain Mr. Speaker, these are five simple those who defraud the Medicare pro- better control over their provider net- ideas to empower the Medicare pro- gram. work. It is easy for a company to do gram to stop the fraud in this system, b This symbol represents the time of day during the House proceedings, e.g., b 1407 is 2:07 p.m. Matter set in this typeface indicates words inserted or appended, rather than spoken, by a Member of the House on the floor. H1583 . VerDate Mar 15 2010 02:15 Mar 09, 2011 Jkt 099060 PO 00000 Frm 00001 Fmt 7634 Sfmt 0634 E:\CR\FM\A08MR7.000 H08MRPT1 PWALKER on DSKD5P82C1PROD with HOUSE H1584 CONGRESSIONAL RECORD — HOUSE March 8, 2011 and this was recommended from the to make sure that they understand comprehensive, patient-centered care hearing what we had in Oversight and their treatment choices and that they that leads to better quality and greater Investigations. It must be stated again are respected. patient satisfaction, and it’s inter- there is an estimated $60 billion to $90 This is an issue that goes far beyond esting that the new polling by the Na- billion in fraud in Medicare every year, the so-called ‘‘end of life.’’ This is key tional Journal and The Regence Foun- and of course, no one over at Health so that everybody knows their health dation makes this abundantly clear. and Human Services knows how much care choices, they understand their is lost. The Secretary of Health and choices, and they make their wishes b 1410 Human Services could not even come known, their choice is honored and re- up with a number. And think of that. spected. These results affirm that health care After 45 years of this program, no one It is a mistake as we have these con- is deeply personal and that people want knows how much fraud is in Medicare, versations to confuse the high cost of to know their options, stay in control and no steps have been taken to really end of life with concerns about health of their care, and be in a position to analyze and find out. Yet we have all care reform. When people are seriously help their loved ones. This poll indi- the baby boomers that are beginning to ill, they have high health care spend- cates that 97 percent of Americans retire. The cost of Medicare will ex- ing, and there is nothing wrong with polled believe that it is important that plode, and the hidden cost of fraud will that. That is a natural consequence of patients and their families be educated increase. what happens when people need more about palliative care and care options My committee will forward the mate- hospitalization, more intense activity. available to them when they’re seri- rial from the Oversight and Investiga- But too often, the sickest and most ously ill. tion hearing to the Health Sub- vulnerable have negative experiences Over 80 percent of Americans polled committee to start to develop legisla- in our complex health care system, believe that discussions about pallia- tion to address these problems with which creates unnecessary strains on tive care and other treatment options Medicare fraud. We have a $1.5 trillion both the patients and the caregivers, should be fully covered by health insur- deficit, and eliminating waste, fraud, and it is a mistake to somehow confuse ance, including Medicare. By a more and abuse is necessary to balance our this with people who are seriously ter- than three to one margin, people iden- budget, and we should start now. minally ill. Forty percent of all people tified that it’s more important to en- hance the quality of life for someone f who are hospitalized can’t make deci- sions for themselves. This is a real who is seriously ill rather than just LIVING WELL AT THE END OF stress on them, on families, and the simply extend life. LIFE: A NATIONAL CONVERSATION ones who have been given the responsi- It pointed out that as a result of The SPEAKER pro tempore. The bility to try and guess what is in their some of the, I would think, bizarre con- Chair recognizes the gentleman from best interests. versation that has surrounded this Oregon (Mr. BLUMENAUER) for 5 min- I have heard countless stories about issue, including the 2009 PolitiFact’s utes.