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Get to Work to Fight Medicare Fraud
Last year, the federal government spent $509 billion on Medicare and another $380 billion on Medicaid. It has been estimated that anywhere from $40 billion to $60 billion was lost to fraud.
The health reform bill enacted in April 2010 gave Medicare officials a new tool to fight fraud. The agency that runs the program is now empowered to impose a temporary enrollment moratorium on new Medicare providers and suppliers when it determines there is a significant potential for fraud, waste or abuse either by the applicant type or within the geographic area.
That makes a lot of sense, and it’s based on fraud-fighting legislation I developed as a leader of the Finance Committee, which has jurisdiction over the Medicare program. Even so, it’s now a year and a half since this law took effect, and the Centers for Medicare and Medicaid Services has failed to impose even one temporary moratorium.
Americans are making every penny count now more than ever, so it’s infuriating that Medicare isn’t using everything it’s got to stop fraud against taxpayers. Plus every dollar lost to fraud is a dollar that isn’t going to serve seniors who rely on Medicare, and the program faces serious fiscal problems.
This week, I teamed up with Senator Orrin Hatch of Utah to send a letter to the Secretary of Health and Human Services, or HHS, to ask why the agency has failed to act in the best interest of taxpayers and Medicare beneficiaries by disregarding this fraud-fighting tool.
There’s really no excuse. This very month, the Department of Justice is operating a strike force initiative as part of a health care fraud and abuse control program. The strike force is at work in seven states, including Florida, where Miami has historically been a high-risk area for Medicare fraud. Earlier this year, during an oversight hearing of the Judiciary Committee, where I serve as the Ranking Member, I questioned the Justice Department about the fact that it sent substantial portions of its budget for these strike forces to HHS for vague initiatives labeled oversight. The fact that HHS has dropped the ball on the new moratorium where fraud is suspected only emphasizes my skepticism about whether HHS has made fighting Medicare fraud a priority and how effectively it has put strike force dollars to work. I want to see the Justice Department increase the number of criminal prosecutions for health care fraud, too. More federal dollars are spent every year on this effort, but the number of prosecutions hasn’t necessarily gone up. Prosecution of those who steal from Medicare is necessary as a matter of accountability and as an effective deterrent against health care fraud.
Separately, I also introduced a bill earlier this year to improve fraud-fighting efforts. A lot of the bill is reform initiatives I’ve been pushing for a long time, as only a small portion of previously introduced legislation was included in the 2010 health care law. My 2011 bill would reform Medicare’s prompt payment rule, to require Medicare officials to delay payments when fraud is suspected. When a federal program opts to pay and chase, fraud is made easier. My pending bill also would require public disclosure of Medicare claims and payments. The way it is now, defense program spending is more transparent than spending by the Medicare program. Disclosure is important because transparency brings about accountability. A third section of my legislation would let the HHS Inspector General exclude individuals from participating in federal health care programs if they’ve been affiliated with known fraud.
The federal government needs to fully exercise its authority to fight fraud, and Congress needs to act to fill the tool box with fraud-fighting resources.
Beyond that, courageous private citizens have proven their tremendous value in fighting fraud against the taxpayers. In 1986, I updated the False Claims Act by empowering individual whistleblowers who step up to identify and expose fraud. I continually work to fortify this law because there are always efforts to weaken it, and a lot of people would like it gutted entirely. Since 1986, the updated False Claims Act has recovered $28 billion that otherwise would have been lost to fraud. While the reform began as a major initiative against defense contractor fraud, during the last 15 years, it’s been the most effective tool against health care fraud and for accountability with health care dollars.
October 28, 2011
Last year, the federal government spent $509 billion on Medicare and another $380 billion on Medicaid. It has been estimated that anywhere from $40 billion to $60 billion was lost to fraud.
The health reform bill enacted in April 2010 gave Medicare officials a new tool to fight fraud. The agency that runs the program is now empowered to impose a temporary enrollment moratorium on new Medicare providers and suppliers when it determines there is a significant potential for fraud, waste or abuse either by the applicant type or within the geographic area.
That makes a lot of sense, and it’s based on fraud-fighting legislation I developed as a leader of the Finance Committee, which has jurisdiction over the Medicare program. Even so, it’s now a year and a half since this law took effect, and the Centers for Medicare and Medicaid Services has failed to impose even one temporary moratorium.
Americans are making every penny count now more than ever, so it’s infuriating that Medicare isn’t using everything it’s got to stop fraud against taxpayers. Plus every dollar lost to fraud is a dollar that isn’t going to serve seniors who rely on Medicare, and the program faces serious fiscal problems.
This week, I teamed up with Senator Orrin Hatch of Utah to send a letter to the Secretary of Health and Human Services, or HHS, to ask why the agency has failed to act in the best interest of taxpayers and Medicare beneficiaries by disregarding this fraud-fighting tool.
There’s really no excuse. This very month, the Department of Justice is operating a strike force initiative as part of a health care fraud and abuse control program. The strike force is at work in seven states, including Florida, where Miami has historically been a high-risk area for Medicare fraud. Earlier this year, during an oversight hearing of the Judiciary Committee, where I serve as the Ranking Member, I questioned the Justice Department about the fact that it sent substantial portions of its budget for these strike forces to HHS for vague initiatives labeled oversight. The fact that HHS has dropped the ball on the new moratorium where fraud is suspected only emphasizes my skepticism about whether HHS has made fighting Medicare fraud a priority and how effectively it has put strike force dollars to work. I want to see the Justice Department increase the number of criminal prosecutions for health care fraud, too. More federal dollars are spent every year on this effort, but the number of prosecutions hasn’t necessarily gone up. Prosecution of those who steal from Medicare is necessary as a matter of accountability and as an effective deterrent against health care fraud.
Separately, I also introduced a bill earlier this year to improve fraud-fighting efforts. A lot of the bill is reform initiatives I’ve been pushing for a long time, as only a small portion of previously introduced legislation was included in the 2010 health care law. My 2011 bill would reform Medicare’s prompt payment rule, to require Medicare officials to delay payments when fraud is suspected. When a federal program opts to pay and chase, fraud is made easier. My pending bill also would require public disclosure of Medicare claims and payments. The way it is now, defense program spending is more transparent than spending by the Medicare program. Disclosure is important because transparency brings about accountability. A third section of my legislation would let the HHS Inspector General exclude individuals from participating in federal health care programs if they’ve been affiliated with known fraud.
The federal government needs to fully exercise its authority to fight fraud, and Congress needs to act to fill the tool box with fraud-fighting resources.
Beyond that, courageous private citizens have proven their tremendous value in fighting fraud against the taxpayers. In 1986, I updated the False Claims Act by empowering individual whistleblowers who step up to identify and expose fraud. I continually work to fortify this law because there are always efforts to weaken it, and a lot of people would like it gutted entirely. Since 1986, the updated False Claims Act has recovered $28 billion that otherwise would have been lost to fraud. While the reform began as a major initiative against defense contractor fraud, during the last 15 years, it’s been the most effective tool against health care fraud and for accountability with health care dollars.
October 28, 2011