E1952 CONGRESSIONAL RECORD — Extensions of Remarks October 7, 1997 renowned author, a distinguished civic leader, A recent audit by the Health and Human FINANCIAL AND COMPLIANCE AUDITS SHOULD BE A COST and an outspoken champion of the rights of Services Office of Inspector General [HHS OF DOING BUSINESS WITH MEDICARE AND MEDICAID District residents. OIG] estimated that approximately $23 bil- I want to highlight one particular provision in I rise to recognize Pastor Hicks on the occa- lionÐabout 14 percent of the total Medicare this billÐthe use of compliance and financial sion of the Metropolitan Baptist Church's 20th fee-for-service benefit paymentsÐhad been audits. Unfortunately, it's relatively easy for Pastoral Jubilee for their pastor, when the improperly paid through the Medicare system. fraudulent operators to escape detection be- more than 7,000 members of the church are These errors included everything from simple cause the Health Care Financing Administra- celebrating his many accomplishments and mistakes to outright fraud. Most improper pay- tion [HCFA], which oversees the Medicare and contributions. Pastor Hicks has been a leader ments were due to the lack of any or ade- Medicaid Programs, is woefully lacking in re- in bringing women into the ministry and has quate documentation to support the claimed sources to provide adequate oversight and to advocated the ordination of women. He has serviceÐlack of medical necessity; incorrect track down abusers. Over the past 7 years, established programs at the church that are coding; and noncovered or unallowable serv- the number of Medicare claims processed much-praised models for churches around the ices. All the money improperly paid, however, rose 70 percent, while HCFA's budget for re- Nation for people living with AIDS and their was wasteful. viewing claims grew less than 11 percent. Ad- families, for prison inmates, for seniors, and RECENT LEGISLATIVE EFFORTS ARE PROMISING BUT NOT justing for claims growth and inflation, funding for youth. He has rebuilt his historic church ENOUGH for review dropped from 74 cents to 48 cents and made it a center for revitalization of its We should be proud of recent legislative ef- per claim. As a result, the proportion of claims inner city neighborhood. forts. The Health Insurance Portability and Ac- reviewed dropped from 17 percent to 9 per- Dr. Hicks has become a leading voice in cent. In the especially problematic home pursuing the democratic right of self govern- countability Act and the Balanced Budget Act of 1997 made significant strides in combating health area, reviews plummeted from 62 per- ment for District residents. When the Con- cent in 1987 to a target of 3 percent in 1996. gress forced a death penalty referendum on fraud, waste, and abuse in the Medicare and Medicaid Programs. With bipartisan coopera- In many industries, it is standard operating the District in 1992, Dr.Hicks was chair of the procedure for businesses to fund independent campaign against the death penalty. He led tion, we enacted unprecedented tools for fight- ing what has become one of the favorite audits of their compliance with Federal laws the campaign not only as a civic leader of the and regulations. For example, banks have community, but also as a minister of the Gos- crimes of the 1990'sÐcheating the Govern- ment of billions of dollars through health care paid for independent government financial and pel who, like many of the ministers in the Dis- compliance audits since the 1800's. In fact, trict, opposes the death penalty on religious fraud. This new legislation designs a fraud fighting program that coordinates the efforts of the Office of the Comptroller of the Currency grounds. is a special branch of the Treasury Depart- Dr. Hicks' dissertation for his doctoral de- a broad array of law enforcement and health care agencies. Equally as important, it author- ment that is fully funded through fees it as- gree from Colgate Rochester Divinity School sesses for conducting bank audits. It's time we in 1972, ``Images of the Black Preacher: The izes funding to support the work of law en- forcement and the development of new detec- do the same for providers and suppliers who Man Nobody Knows,'' was published in 1977. do business with the Medicare and Medicaid Since then he has been widely published in tion and enforcement techniques. Total fines, restitutions and recoveries programs. religious publications. His two most recent vol- Health care spending consumes an ever-in- achieved this year from OIG criminal and civil umes are ``Preaching Through a Storm'' and creasing portion of the Federal budgetÐnow investigations totaled $1.2 billion. This is five ``Correspondence with a Cripple From Tar- at least 20 percent. And the Federal Govern- times higher than recoveries for fiscal year sus.'' ment pays a third of our Nation's health care In recognition of his extraordinary talent in 1996. Approximately 2,500 health care provid- billsÐmore than any other single source. We his calling, Ebony named Dr. Hicks one of the ers and entities were excluded from doing are the largest purchaserÐisn't it time we be- ``Fifteen Greatest African-American Preachers'' business with the Medicare, Medicaid, and come a wiser purchaser? And isn't it impera- in 1993. Mr. Speaker, I ask that Members of other Federal and State health care programs tive that we have tighter reins on an area that this body, the U.S. House of Representatives, because of violations of the lawÐan 80-per- consumes so many of our tax dollars? join me in saluting the dynamic leadership of cent increase from the 1,400 exclusions in fis- Banks have for many decades borne the fi- Rev. Dr. H. Beecher Hicks, Jr. cal year 1996. nancial responsibility for demonstrating their f Although we're heading in the right direc- legitimacy. It is an accepted cost of the privi- tion, massive fraud schemes to defraud the MEDICARE AND MEDICAID BENE- lege of keeping other people's money. Medi- Government continue. Here are just a few ex- FICIARY PROTECTION ACT OF care and Medicaid providers are being given amples. 1997 the privilege of taking taxpayers' money, with- A psychologist billed for more than 24 hours out the corresponding responsibility for proving HON. FORTNEY PETE STARK of therapy in a single day. their legitimacy. The appalling level of fraud, A home health agency charged for visits to waste and abuse in the programs is the unfor- OF CALIFORNIA patients' homes when the patients were actu- IN THE HOUSE OF REPRESENTATIVES tunate result. ally hospitalized. HHS doesn't have the funding to audit all Tuesday, October 7, 1997 A nursing home submitted claims for sur- categories of providers that have abusive track Mr. STARK. Mr. Speaker, today I am intro- gical dressings on behalf of patients who had records. Even if it did, taxpayers shouldn't ducing the Medicare and Medicaid Beneficiary not undergone surgery. have to foot the bill. Twenty three billion dol- Protection Act of 1997, a bill designed to con- A fictitious diagnostic firm collected payment lars says it's time to make Federal audits a tinue our fight against health care fraud, for nonexistent lab work on dead people. cost of doing business with the Nation's larg- waste, and abuse in the Medicare and Medic- One beneficiary was charged $5,290 for est health care payer, the Federal Govern- aid Programs. tape over a 6-month period of which $5,000 ment. THE PROBLEM was excessive. Medicare paid for but the ben- WE SHOULD BE DILIGENT IN OUR FIGHT AGAINST HEALTH The General Accounting Office [GAO] has eficiary probably did not receive, 66,000 feet CARE FRAUD estimated that fraud and abuse could be as or 12.5 miles of 1-inch tape. It's simple for meÐindividuals found to in- much as 10 percent of total health care Although recent legislation is a good first tentionally, systematically and repeatedly de- spending. This best estimateÐthat 10 percent step, we need to do more. In a August 19, fraud Medicare and Medicaid should go to jail. of the Nation's $1 trillion health bill is lost in 1997, statement, Gregory Anderson, director We should have a zero tolerance for repeat waste, fraud, and abuseÐincludes both the of corporate and financial investigations for offenders. We should not hide behind free private and public sector. Consider this . . . Blue Cross and Blue Shield of Michigan said market language as an excuse for criminal be- Federal baseline outlays for Medicare are ap- it bestÐdespite increased enforcement and havior. The fight against health care fraud proximately $208 billion in fiscal year 1998Ð the publicity of million dollar settlements with should be aggressive and on-going. Medicare and 10 percent of waste, fraud, and abuse large, multi-State health corporations, ``the re- beneficiaries deserve the best we can offerÐ roughly equals the $23 billion we cut each wards outweigh the risks today.'' quality care at an affordable price with strong year in this year's budget reconciliation bill. If The bill I am introducing today aggressively protections against unscrupulous providers. we were tougher on health care fraud, we continues the fight. My message should be The following is a summary of the bill: wouldn't have to cut payments from the hon- clear to those who do business with Medicare I. Title IÐRevisions to Sanctions for Fraud est, hardworking providers who justly should and MedicaidÐthe fight against health care and Abuse receive payment for their services. fraud is just beginning. A. Subtitle AÐExclusion Authority October 7, 1997 CONGRESSIONAL RECORD — Extensions of Remarks E1953 1. Sec. 101ÐClarifies the application of 1. Sec. 301ÐFees for agreements with ing. As one who is singularly conscious of this mandatory exclusion based on felony convic- Medicare providers and suppliers. issue, I want to call attention to this issue, be- tions relating to controlled substances to indi- 2. Sec. 302ÐEstablishes requirements and cause Asian-Americans have as much right to viduals involved in health care. fees for Medicare overpayment collections. participate in the political process as do Amer- 2. Sec. 102ÐClarifies the period of exclu- 3. Sec. 303ÐRequires an administrative fee icans of any other national origin. Deliberately sion based on loss of license. for Medicare overpayment collection. or otherwise, Asian-Americans have been the 3. Sec. 103ÐClarifies the application of IV. Title IVÐPayment Improvements target of both of these investigations to an un- sanctions to Federal health care programs. A. Subtitle AÐMental Health Partial Hos- acceptable and overwhelming degree. B. Subtitle BÐCivil Monetary Penalties pitalization Services While some might consider the question of 1. Sec. 111ÐRepeals the clarifications con- 1. Sec. 401ÐLimits location of provision of Asian bashing ludicrous and outrageous. Or- cerning levels of knowledge required for the services. ganizations representing Asian-Americans do imposition of civil monetary penalties. 2. Sec. 402ÐClarifies qualifications for com- not. A petition with the U.S. Commission on 2. Sec. 112ÐAllows for civil monetary pen- munity mental health centers. Civil Rights was filed on behalf of the leading alties to be applied for services ordered or 3. Sec. 403ÐRequires audit of providers of organizations representing Asian-Americans. prescribed by an excluded individual or entity. partial hospitalization services. These organizations believe that members of 3. Sec.113ÐPermits HHS to pursue civil 4. Sec. 404ÐImplements prospective pay- some of this Nation's most important institu- monetary penalty actions after consulting with ment system for partial hospitalization serv- tions have acted irresponsibly and carelessly the Attorney General. ices. to allegations of campaign finance wrongdoing 4. Sec. 114ÐClarifies payment practice ex- 5. Sec. 405ÐProvides for a demonstration by scapegoating and stereotyping of Asian- ception authority to definition of remuneration. program for expanded partial hospitalization Americans. 5. Sec. 115ÐExtends subpoena and injunc- services. In point of fact, affiliates and subsidiaries of tion authority. B. Subtitle BÐRural Health Clinic Services foreign-owned corporations have made vastly 6. Sec. 116ÐClarifies amounts of civil mon- 1. Sec. 411ÐDecreases beneficiary cost greater contributions to both political parties etary penalties. sharing for rural health clinic services. than the issues that we are dealing with in the 7. Sec. 117ÐApplies anti-dumping sanc- 2. Sec. 412ÐImplements a prospective pay- Burton investigation. A Canadian-owned cor- tions against physicians who refuse an appro- ment system for rural health clinic services. poration gave $2 million to the political parties. priate transfer at a hospital with specialized f An Australian-owned corporation gave capabilities or facilities. $674,000, and an additional $1 million to the C. Subtitle CÐCriminal Penalties CAMPAIGN FINANCE HEARINGS California Republican Party. Brown and 1. Sec. 121ÐKickback penalties for knowing ARE CREATING AN ATMOSPHERE Williamson, a British-owned tobacco company, violations OF DISCRIMINATION AGAINST gave $642,000. 2. Sec. 122ÐRepeals expanded exception ASIAN-AMERICANS None of these foreign-owned corporations for risk-sharing contract to anti-kickback provi- have been the subject of any inquiry by either sions HON. TOM LANTOS 3. Sec. 123ÐExpands criminal penalties for the Senate or House committee. As a matter OF CALIFORNIA kickbacks of fact, in July, the Federal Election Commis- 4. Sec. 124ÐTreats certain Social Security IN THE HOUSE OF REPRESENTATIVES sion levied the largest fine in history on a for- Act crimes as Federal health care offenses Tuesday, October 7, 1997 eign contribution, and that contribution was made by a citizen of German origin. He has D. Subtitle DÐMiscellaneous Provisions Mr. LANTOS. Mr. Speaker, a number of 1. Sec. 131ÐRepeals HIPAA advisory opin- not been hauled before either committee. concerns have been expressed over the past Mr. Speaker, it would be absurd and an es- ion authority few months regarding the manner in which 2. Sec. 132ÐClarifies identification numbers cape from reality to argue that there is not an Chairman BURTON and the majority members Asian tone to these hearings. It is my hope to be used with adverse action data base of the House Government Reform and Over- 3. Sec. 133ÐClarifies who may have ac- that as hearings in the House commence that sight Committee have conducted their inves- cess to information in adverse action data we will all remain acutely conscious of these tigation into campaign finance abuses during bank most sensitive issues. the 1996 election campaign. There have been II. Title IIÐImprovements in Providing Pro- f complaints that the investigation is too par- gram Integrity tisan, that it is duplicative and poorly man- IN HONOR OF NEW YORK STATE A. Subtitle AÐGeneral Provisions SENATOR LEONARD P. STAVISKY 1. Sec. 201ÐLimits the use of automatic aged. After 9 months and literally millions in stays and discharge in bankruptcy proceed- taxpayer funds, this investigation has been ings for provider liability for health care fraud. beset with delays, staff resignations, poorly HON. CHARLES E. SCHUMER 2. Sec. 202ÐRequires certain providers to conducted investigations, and bungled proce- OF NEW YORK fund annual financial and compliance audits dures. IN THE HOUSE OF REPRESENTATIVES At the recent meeting of the committee at as a condition of participation under the Medi- Tuesday, October 7, 1997 care and Medicaid programs which committee members voted to extend im- 3. Sec. 203ÐMakes clear that Medicare munity to a few witnesses who will testify at a Mr. SCHUMER. Mr. Speaker, one of the carriers and fiscal intermediaries and State hearing later this week, I raised a matter of pleasures of serving in this legislative body is Medicaid agencies are liable for claims sub- the most serious concern to me. Mr. Speaker, the opportunity we occasionally get to ac- mitted by excluded providers. I would like to call to the attention of the knowledge publicly outstanding individuals in 4. Sec. 204ÐReforms Medicare Hospital House those concerns which I raised during our communities. Outpatient Payment Policies. the meeting of the committee. The Franklin D. Roosevelt Democratic Asso- 5. Sec. 205ÐStandardizes forms used for Mr. Speaker, this House and the committee ciation of New York will be presenting its first certifications of medical necessity and certifi- investigating campaign finance must be par- ever Life-Time Achievement Award to State cations of terminal illness. ticularly sensitive about the possible discrimi- Senator, and dear friend of mine, Leonard P. 6. Sec. 206ÐNo mark-up for drugs, natory effects that the investigation may have Stavisky. To list the accomplishments of this biologicals or nutrients; requires use of na- on Asian-Americans. There is a grave danger great man would take up more pages that I tional drug code numbers in Medicare claims. that stereotyping and Asian bashing will be- would be allocated in the CONGRESSIONAL 7. Sec. 207ÐAdjusts hospital payments to come, and in many instances have become, RECORD. To those of us who know him so reflect excess payment resulting from a finan- part and parcel of this investigation. well, I do not have to tell you of the Senator's cial interest with downstream facilities. There is a long history of discrimination accomplishments in the field of education, city Subtitle BÐOther Provisions against Asian-Americans in this country. We and State government, and the many issues 1. Sec. 211ÐInclusion of cost of home all remember chapters of that history, perhaps with which he has been involved. I am just health services in explanation of Medicare the most shameful of which is the incarcer- amazed that one person could accomplish so benefits. ation of tens of thousands of United States much. 2. Sec. 212ÐProhibits ``cold-call'' marketing citizens of Japanese origin during the Second I congratulate you Leonard for over 30 for Medicare+Choice plans. World War. years of service dedicated to the public good. III. Title IIIÐProvider Enrollment ProcessÐ This investigation, perhaps inadvertently, Your example and your friendship over the Fees has contributed to stereotyping and race bait- years has meant so much to me, and I am