[Congressional Record Volume 144, Number 11 (Thursday, February 12, 1998)]
[Senate]
[Page S716]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




         PREVENTING FRAUD AND ABUSE WITHIN THE MEDICARE PROGRAM

  Ms. COLLINS. Mr. President, as the Congress grapples with the problem 
of maintaining the solvency of the Medicare program and with proposals 
to expand Medicare coverage, we must not overlook a critical problem 
that threatens the financial integrity of this vital social program, 
which provides health care services to 38 million older and disabled 
Americans. I am talking, Mr. President, about the problem of waste, 
fraud and abuse in this program.
  The Permanent Subcommittee on Investigations, which I chair, has 
undertaken an extensive investigation into Medicare fraud.
  At our first hearing last summer, we learned from the inspector 
general of the Department of Health and Human Services that an 
astounding $23 billion a year is lost to waste, fraud, abuse and other 
improper payments.
  In more recent hearings, Mr. President, we discovered that career 
criminals, with absolutely no background in health care, were able to 
be certified as Medicare providers and enter the system for the sole 
purpose of ripping it off.
  For example, one case that the subcommittee investigated involved a 
totally fictitious durable medical equipment company that was located 
in the middle of the runway of the Miami International Airport, if it 
had in fact existed.
  I am not talking here, Mr. President, about legitimate providers or 
innocent mistakes or honest billing errors. I am talking about outright 
fraud. We need to do a better job of screening providers and 
controlling their entry into the Medicare system.
  Mr. President, the vast majority of health care professionals are 
dedicated and caring individuals who deliver vital services to millions 
of Americans across the country. They are as appalled by this kind of 
fraud as any of us.
  Recently, I met with the members of the Home Care Alliance of Maine 
concerning the issue of fraud in the health care industry. The Home 
Care Alliance of Maine has a longstanding commitment to ensuring the 
highest quality home health care in the State of Maine. It has adopted 
a policy of zero tolerance on fraud and abuse in the home health 
industry. Its members recognize that unscrupulous home health providers 
not only tarnish the reputation of legitimate health care 
professionals, but that these unscrupulous individuals jeopardize the 
very availability of Medicare.
  I ask unanimous consent the position statement of the Home Care 
Alliance of Maine be printed in the Record so my colleagues and 
organizations representing home health care agencies across the United 
States can have the benefit of the very fine work this organization has 
done.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                        Medicare Fraud and Abuse


                           position statement

       The Home Care Alliance of Maine membership has a long-
     standing commitment to provide the highest quality of care to 
     the elderly and infirm of our state. Even one unscrupulous 
     home health provider that fails to maintain the values and 
     ethics that are at the core of home care jeopardizes the 
     viability of ongoing access to appropriate home health 
     services.
       We recognize that the responsibility for resolving concerns 
     of fraud and abuse lies with the government, the home health 
     industry, and individual providers. We further believe that 
     different strategies are needed to clearly distinguish 
     deliberately fraudulent practice from unintentional errors 
     that can occur in the interpretation of the complex and often 
     vague rules and regulations in the Medicare home health care 
     benefit.
       The Home Care Alliance of Maine firmly believes that fraud 
     and abuse can be eliminated and errors corrected when 
     addressed by comprehensive and concerted efforts among the 
     industry, government, individual providers, and consumers. 
     This partnership is critical to achieve the mutually 
     beneficial goal of assuring integrity in administration of 
     the Medicare home health care benefit.
       We further believe that education of consumers and advocacy 
     groups is central to ensuring trust in legitimate providers 
     of home health services. It is only through open and public 
     discussion about the basic structure of changes in the 
     Medicare home health care benefit that consumers and others 
     can confidently distinguish blatant fraud and abuse from 
     innocent errors in interpretation and provision of services. 
     Informed consumers and their advocates can then be reassured 
     by their choice of licensed and certified home health 
     agencies.
       The Home Care Alliance of Maine supports:
       1. Zero tolerance for fraud and abuse of the Medicare home 
     health care benefit.
       2. Total cooperation with prompt and responsible 
     investigation and resolution of any errors in interpretation 
     and application of the Medicare home health care benefit.
       3. Medicare coverage and reimbursement standards in 
     language that is understandable and readily accessible to 
     providers and consumers through various means, e.g. federal 
     depository libraries, state regulatory agencies, trade 
     associations, fiscal intermediaries, and the Internet.
       4. Enhancement of education and training of home health 
     agencies through joint efforts with regulators.
       5. Credentialing and competency testing standards for 
     government contractors and federal regulators responsible for 
     issuing Medicare determinations.
       6. Mandatory screening and background checks on all 
     applicants for Medicare certification as a home health 
     agency.
       7. Development and provision of a summary of program 
     coverage requirements for consumers and prospective consumers 
     of Medicare home health care benefits.
       8. Enhancement and increased accessibility of the consumer 
     reporting hotline for suspected fraud and abuse.
       The Home Care Alliance of Maine is committed to working 
     with its membership, state and federal regulatory bodies, and 
     consumer advocacy groups to ensure the integrity of the 
     Medicare home health care benefit in Maine.

  Ms. COLLINS. I appreciate the opportunity to comment on this issue.
  I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The legislative clerk proceeded to call the roll.
  Mr. COVERDELL. Mr. President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.

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