[Congressional Record Volume 144, Number 10 (Wednesday, February 11, 1998)]
[House]
[Page H411]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                          MEDICARE LEGISLATION

  The SPEAKER pro tempore. Under a previous order of the House, the 
gentleman from Iowa (Mr. Ganske) is recognized for 5 minutes.
  Mr. GANSKE. Mr. Speaker, I think it is important that we inform the 
public in terms of a specific on the Medicare legislation that we 
passed last year. Many of our citizens are seeing articles in Newsweek 
Magazine and other magazines about the rampant fraud and abuse in 
Medicare, and so we have been working on ways to try fix that.
  The Balanced Budget Act, which was enacted last year, incorporated a 
provision regarding eligibility for home health care benefits. 
Previously, a Medicare recipient who received venipuncture, drawing of 
blood, automatically qualified for a full range of other home health 
services, including skilled nursing care, physical therapy, medical 
social services, and home health aide services for assistance with 
bathing, cooking and cleaning just for having a blood draw.
  Under the new law, a Medicare recipient requiring venipuncture 
services at home can still receive those services; however, the receipt 
of a venipuncture alone will not make that individual eligible for 
other home health services. Medicare will continue to provide home 
health services for those who are homebound if the physician has 
certified that home care is necessary and has established a plan of 
care.
  The new law removes the ``venipuncture loophole,'' unquote, which 
resulted in the provision of home care to seniors who were not 
homebound or who did not have a demonstrable medical need for home 
health services. Now, the reason for this is that once a very small 
part of Medicare spending for home health care has increased at a very 
rapid rate in the last decade. Even accounting for inflation, home 
health care spending jumped more than fivefold between 1985 and 1996. 
While some of that expansion has been the result of an increase in the 
number of seniors taking advantage of home health benefits, an alarming 
amount of the home health budget is lost to various forms of fraud and 
abuse.
  In hearings last year, the Committee on Commerce, on which I serve, 
heard from investigators from the General Accounting Office and the 
Office of the Inspector General about the fraud rampant in the home 
health benefits. One review, which included more than 3,700 services in 
4 States, found that 40 percent, that is 40 percent, did not meet 
Medicare reimbursement requirements.
  Another review of high-dollar home health claims in one State found 
that 43 percent should have been partially or totally denied. Equally 
troubling was an antifraud initiative by the Department of Health and 
Human Services that found that taxpayers were footing the bill for the 
venipuncture loophole. Many physicians were found to use blood 
monitoring as the sole reason for ordering home health services, 
resulting in numerous health aide visits from Medicare beneficiaries 
with no medical need for skilled nursing or therapy. The average cost 
of drawing blood for these individuals was over $100 because the visit 
was billed as a skilled nursing visit.
  If these same services were performed as a blood draw under Part B of 
Medicare and the individual did not receive additional home health 
services for which they were not qualified, Medicare would only pay $3 
for that specimen collection. Medicare could separately pay for the 
cost of a technician to travel to the home of an individual needing a 
venipuncture service if the beneficiary is unable to travel to a 
doctor's office or travel to a lab for a blood draw. But that would 
still be significantly less costly than the $100 billed because of a 
skilled nursing visit.
  Mr. Speaker, the reforms passed by Congress will help keep Medicare 
solvent until about the year 2010. The wave of baby-boomers will begin 
retiring that year and will place severe financial strain on the 
program. Today there are about 4 workers for every retiree. By 2030 
there will be just a little over 2 for each retiree.
  Congress has to make fundamental changes in the Medicare program to 
make sure it is there for recipients in the future, and one way to do 
that is to root out fraud and waste in the Medicare system, and one way 
to do that is to make sure that those who need a venipuncture, but only 
a venipuncture, can get those services through a draw but not 
necessarily get additional services that are very, very costly. People 
need to consider that when they look at this provision.

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