[Congressional Record Volume 141, Number 96 (Tuesday, June 13, 1995)]
[House]
[Page H5894]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                            FIXING MEDICARE

  The SPEAKER pro tempore. Under a previous order of the House, the 
gentleman from Michigan [Mr. Knollenberg] is recognized for 5 minutes.
  Mr. KNOLLENBERG. Mr. Speaker, the American people are way ahead of 
Congress in knowing what is wrong and right with the Medicare system. I 
appreciate this opportunity to share with the body just one example of 
the disturbing waste that occurs in our Medicare bureaucracy. I first 
heard this story last week when it aired on WJBK-TV2 in Detroit during 
a segment called the ``Hall of Shame.''
  Mrs. Jean English, while going through the mail of her recently 
deceased brother, found a bill for his last hospital stay. Her brother, 
suffering from a terminal illness, died only a few days after being 
admitted.
  The bill for the 4-day period came to $368,511.09. All of it had been 
forwarded to Medicare for payment. Shocked by the outrageous expense, 
Mrs. English called the hospital for an explanation. What she got was a 
14-page itemized statement. And the greatest expense? $342,982.01 for 
emergency room supplies for a 7-hour stay in the ER.
  Well, after much hemming and hawing, the hospital admitted that it 
had made a mistake.
  Oops. Instead of $347,982.01, the actual charge should have been 
$61.30. That is right $61.30. An overcharge of $347,920.71! The problem 
was found.
  End of story? Hardly. The errant bill had
   been sent to Medicare and paid by Medicare. That is right--they paid 
the bill. Now Jean found the mistake--a bill for $350,000 seemed a 
little excessive to her. Didn't the people at Medicare notice that 
supplies for the ER had become a little expensive?

  Well, in all fairness, Medicare's computer noticed the problem--sort 
of. The bill total seemed large so Medicare cut it by 70 percent paying 
the hospital $67,000. But the actual cost of care was only $25,000. 
Medicare found the problem and still overpaid by $50,000. And Medicare 
claims this system works?
  And when this was brought to the attention of the folks over at 
Medicare they said, and I quote, ``This case shows . . . that the 
Medicare system worked as expected.'' If the system is expected to work 
like this no wonder it will be bankrupt in 7 years.
  When Medicare determined the bill was in error why didn't they look 
at the items to find the mistake? After all, $350,000 for supplies 
seemed unreasonable to Jean. Don't the people working for Medicare 
notice a charge of $350,000 for supplies? Or is this happening all the 
time? ``Close enough for government work'' is an old adage that seems 
to be true here.
  And why, Mr. Speaker, does Medicare arbitrarily cut 70 percent off if 
the bill seems in error? According to its own statement this is how the 
problem was fixed. ``When the bill was received from the hospital, the 
system automatically reduced it by more than 70 percent.'' It may sound 
like a solution but the example here shows why this kind of logic is 
helping to bankrupt the Medicare system.
  The actual charge for the supplies should have been $61.30. That's 
only .0002 percent of what Medicare was charged. And Medicare paid 30 
percent of the full charge--$67,000--resulting in a huge overpayment. 
How hard is it to look at a bill that has already set off the alarms as 
being incorrect and find exactly what isn't right?
  I am disturbed that Medicare seems to believe that just cutting the 
total amount paid addressed the problem. Now maybe I am too naive but I 
believe the system should fix its mistakes not just automatically cut a 
bill by 70 percent. Shouldn't the details of the bill be looked at? Are 
all bills automatically cut by 70 percent?

                              {time}  2130

  This system makes no sense. If we are to save Medicare from 
bankruptcy we must find the solutions to problems like this. I stand 
here today because I know this story is not unique. Jean English found 
the mistake and brought it to our attention. But how many errant bills 
go unnoticed? And at what cost to the system and our seniors.
  Let us work together with the American people to stop waste in the 
system. Let us fix the problem and save Medicare before it gets too 
late.


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