[Congressional Record Volume 143, Number 159 (Wednesday, November 12, 1997)]
[Extensions of Remarks]
[Page E2333]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]


 WHY BETTER CERTIFICATES OF MEDICAL NECESSITY ARE NEEDED TO HOLD DOWN 
                             MEDICARE FRAUD

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                        HON. FORTNEY PETE STARK

                             of california

                    in the house of representatives

                      Wednesday, November 12, 1997

  Mr. STARK. Mr. Speaker, on October 7, I introduced H.R. 2633. to 
require the Secretary of HHS to develop and require the use of standard 
forms by which physicians certify that a course of home health or 
hospice care is necessary and appropriate.
  Today, doctors just sign for such services without a clear statement 
that the patient qualifies or is eligible for the course of treatment. 
Often a doctor is nagged into approving the course of treatment by the 
family or patient, and I know that many doctors would like to be able 
to explain to patients why they cannot casually certify an expensive 
Medicare benefit, but instead, various conditions of medical need must 
be met.
  A clearer, consistent statement of CMN can help reduce fraud. For 
example, there is the complaint of the United States versus Joseph Ari 
Kirschenbaum, filed this October 14 in the U.S. District Court for the 
Northern District of Illinois (Eastern Division), No. 97 CR 702. In the 
grand jury's charges and in the complaint, Mr. Kirschenbaum is charged 
with defrauding Medicare of millions of dollars by providing --or not 
providing--hospice benefits to Medicare beneficiaries.
  Following is one of the many charges from the grand jury. It is 
important to note that Doctor K and the other doctors mentioned in this 
charge are not--to my knowledge--being charged with the hospice owner. 
A reformed and strengthened CMN system, as provided in H.R. 2633, would 
help ensure that doctors would not casually sign such stacks of paper, 
and if they did, would be liable for false certification.


       58. It was further part of the scheme that defendant 
     KIRSCHENBAUM hired a Medical Director for Samaritan Care who, 
     in exchange for a modest salary, was willing to sign every 
     patient certification form that was presented to him without 
     examining the patients or reviewing the patients' medical 
     records. This Medical Director, referred to in this 
     indictment as ``Doctor K,'' had no involvement in the hospice 
     other than signing his name to patient forms every two weeks 
     at the Samaritan Care office. Often the patients had been 
     receiving hospice care for several days before Doctor K first 
     learned of the patients when he received the certification 
     forms to sign. Kirschenbaum never informed Dr. K of the 
     extensive responsibilities of the Medical Director as set 
     forth in the Policies and procedures, and Dr. K did not 
     fulfill these responsibilities. Kirschenbaum later employed 
     other Medical Directors at modest salaries who signed 
     certification forms without seeing patients or reviewing 
     their medical records.

     

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