By Sen. Chuck Grassley of Iowa
Over the course of my public service, I’ve found sunshine to be the most effective way to promote transparency and accountability in the federal government. A key source of that sunshine, and a formidable weapon in the fight against fraud, is the whistleblower. Whistleblowers put themselves at great risk to report wrongdoing in order to protect taxpayers and promote government efficiency. Over the past several decades, whistleblowers have helped save billions of taxpayer dollars by shining light on fraud committed, in particular, by health-care companies and government contractors seeking to bilk our health-care system.
But due to the personal risk whistleblowers can face, potential whistleblowers are often afraid to come forward with information that would help the government hold fraudsters accountable. That’s why in 1986, I authored amendments to the False Claims Act to encourage whistleblowers to report waste, fraud, and abuse of federal programs. My amendments allow whistleblowers to share in the assets recovered from fraud cases. They have helped the government recover more than $56 billion from 1987 to 2017, with 72 percent of that total coming from actions initiated by whistleblowers.
The False Claims Act is the most effective tool we have to fight government fraud, protect taxpayer dollars, and promote safety and accountability. Empowering whistleblowers to help prosecute fraud is common sense. They often know the system better than outsiders and are more effective than trusting the government to police itself.
But this doesn’t mean members of Congress can neglect their oversight responsibilities, particularly concerning health care. The taxpaying public bears a heavy financial burden from health-care costs, making oversight imperative for fiscal responsibility as well as consumer safety. Members of Congress must work to protect each tax dollar and strengthen the integrity of the U.S. health-care system. As part of my commitment to congressional oversight, I’ve worked to improve transparency and accountability in health care for more than a decade.
Those bipartisan oversight efforts resulted in the Physician Payment Sunshine Act, legislation that was enacted as a part of the Affordable Care Act. It requires drug and medical device manufacturers to report annually to the Centers for Medicare and Medicaid Services any transfers of value to physicians or teaching hospitals. After a 30-day review period, the information is made public on the Open Payments website.
The fifth release of reporting data was just completed in March of 2018. It included information regarding more than 11 million financial transactions attributed to 628,000 physicians and 1,158 teaching hospitals totaling $8.4 billion. The total since reporting began is $33.42 billion.
While many of these are legitimate payments to physicians and hospitals for patient care and research, all patients deserve to know if their doctor or hospital has a financial interest in a drug or device used in a treatment or recommended to them. Senator Richard Blumenthal (D-CT) and I have introduced bipartisan legislation to add nurse practitioners and physicians assistants to this transparency program. That legislation could soon be included in a series of anti-opioid bills being completed in the Senate.
Another serious problem plaguing the nation is drug pricing, which is rife with secrecy and complexity. The lack of transparency is detrimental to millions of Americans who need these life-saving medications but can’t afford them. The EpiPen fiasco perfectly illustrates this widespread problem.
During the Obama administration, I heard repeatedly from Iowans at my annual 99 county meetings, as well as through phone calls and letters, that they were paying sky-high prices for the EpiPen, an emergency auto-injector of epinephrine used to treat severe, life-threatening allergic reactions. Through extensive oversight, it came to light that the drug manufacturer was exploiting the Medicaid Drug Rebate program by classifying this popular anti-allergy medicine as generic instead of brand-name. That move allowed it to issue smaller rebates to government programs, such as Medicaid. My oversight also found that taxpayers were on the hook for exorbitant overpayments for the better part of a decade starting in 2006 because of that misclassification. Those costly, anti-competitive practices were confirmed by the government’s internal watchdog when it found that taxpayers may have overpaid for the EpiPen by as much as $1.27 billion over 10 years.
With EpiPen and too many other medications, pharmaceutical companies have gamed the system and left taxpayers holding the bag. Thankfully, the Food and Drug Administration recently announced its approval of the first genuinely generic EpiPen. This is good news for the millions of Americans who depend on this life-saving anti-allergy device but can’t afford to pay hundreds or even thousands of dollars for their prescriptions.
The federal government needs to do a better job enforcing the law and overseeing its programs, not only in health care, but across all agencies. In places where the law falls short, Congress needs to enact reforms that would plug loopholes and hold wrongdoers accountable for taking taxpayers for a ride.
That’s why congressional oversight is so important, and why it’s been a centerpiece of my work as a U.S. senator. Many of my colleagues on both sides of the aisle have joined me in the important business of oversight. Oversight needs to be a priority for each member of Congress in order for us to achieve real change in the federal bureaucratic culture. The health, safety, and livelihoods of the American people depend on it.
Republican Sen. Chuck Grassley represents Iowa. He is chairman of the Judiciary Committee and a senior member and former chairman of the Finance Committee.