[Congressional Record Volume 141, Number 146 (Tuesday, September 19, 1995)]
[House]
[Pages H9139-H9140]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                     SLOWING THE GROWTH OF MEDICARE

  The SPEAKER pro tempore. Under the Speaker's announced policy of May 
12, 1995, the gentleman from Florida [Mr. Stearns] is recognized during 
morning business for 5 minutes.
  Mr. STEARNS. Mr. Speaker, I would say to the gentleman from Texas, if 
he wishes a copy of the plan, he certainly can read about it in the 
Wall Street Journal, he can read about it in the Washington Post or the 
Washington Times. Furthermore, the slowing of the growth in Medicare is 
what has been proposed by Republicans, it is pretty much what President 
Clinton proposed last year in his health care bill. So what we are all 
trying to do here is to slow the growth down and save the program.
  Mr. Speaker, this morning I am here to talk about Medicare and 
Medicaid together, the program for our elderly, disabled, and low-
income women and children, but I am here to talk again about waste, 
fraud, and abuse in this program.
  The spending on these programs, as my colleagues know, has gone up at 
10.5 percent In the private sector, it has gone up at 4.5 percent. We 
need to bring the spending down, but part of the reason the spending 
has gone up so high is because of the waste, fraud, and abuse in these 
programs. Some people estimate this waste, fraud, and abuse at 12 
percent of these two programs, or $30 billion, as high as $44 billion 
for the two programs combined.
  An indication of how pervasive this program is was summed up recently 
by a Clinton high official. This person was the Human Services 
Inspector General, June Gibbs Brown, and this is what she said, Mr. 
Speaker: ``The basic structure of the current health care system is 
almost as if it had been designed for the very purpose of promoting 
waste, fraud, and abuse.'' Now, that is a startling admission.
  The truth is that such behavior is not restricted to just one 
segment. Providers and beneficiaries alike seem guilty of bilking the 
system for personal gain. Examples of these have been recounted in 
numerous hearings on the Committee on Commerce on which I serve and the 
Health Care Subcommittee. However, today I will share with you several 
examples that have been reported in the Reader's Digest.
  I was heartened by the fact that this wonderful publication has 
presented this because so many readers subscribe and purchase the 
Reader's Digest, and so they too will be able to identify the waste, 
fraud, and abuse from these articles.
  The first step is to identify the sources of abuse and then to put 
the mechanism into place that will correct the situation and prevent 
such abuse in the future. We, in our plan, do that.
  One such scheme that was reported in the Reader's Digest dealt with a 
doctor. His wife and his 14-year-old daughter were working together. 
The doctor assigned his 14-year-old daughter the task of taking and 
reading the x rays. On a good day, the office submitted 180 claims. The 
take was $4.5 million over the year for this particular doctor, his 
wife, and his daughter. They submitted these fraudulent claims to some 
40 insurance companies. What finally finished this lucrative and costly 
scam was that the Customs officials became suspicious when, during the 
course of investigating drug money laundering, they noticed that the 
doctor's check cashing patterns were strange. It makes one wonder why 
this was not detected by the Health Care Financing Administration. Are 
they not the body that is supposed to detect this?
  Mr. Speaker, earlier this year, one of HCFA's contractors suspended 
five computer-alert programs that had saved taxpayers $4 million in 
just 3 months. Why was this done? The volume of suspicious claims had 
become impossible for the staff to review. In fact, the General 
Accounting Office found that half of Medicare fraud and abuse 
complaints are not even investigated. The GAO told Congress, ``HCFA 
needs to guard a thousand doors, but has the resources for only a 
couple doors.''

[[Page H9140]]

  Perhaps the most egregious account that was cited involved the 
National Medical Enterprise, which was a $3.9 billion New York Stock 
Exchange company that owned psychiatric hospitals, which operated 86 
psychiatric hospitals nationwide. Sadly enough, witnesses testified 
before the State legislators that social workers, school counselors, 
probation officers, and even ministers served as, quote, 
``headhunters'' and were paid bounties for referring individuals to 
some of these hospitals.
  In Texas, a Texas State senator led the investigation of this in his 
State and stated, quote, ``people were locked up against their will. 
Then they were miraculously cured when their insurance benefits ran 
out.''
  My own State of Florida also has its share of con artists. In fact, 
in March of this year, Florida Medicaid found that at least six taxicab 
companies and two individuals were ripping off the Medicaid Program 
designed to give needy patients free rides to the doctors. In the 
course of 317 days, one company received $1,134,164 for driving 
patients over 1 million miles. As one investigator wryly noted, ``That 
is enough to travel 41 times around the Earth at the equator.''
  My colleagues, the Republican plan includes ways to stop waste, 
fraud, and abuse and it is important we address this matter 
immediately. No matter which party you represent, which side of the 
aisle you are on, we can all agree that waste, fraud, and abuse is 
something that bothers most Americans and we need to stop it now.

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