[Congressional Record Volume 144, Number 56 (Thursday, May 7, 1998)]
[Senate]
[Pages S4528-S4530]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. BAUCUS (for himself, Mr. Graham, Mr. Breaux, Mr. Reid, Mr. 
        Grassley, Ms. Mikulski, and Mr. Johnson):
  S. 2040. A bill to amend title XIX of the Social Security Act to 
extend the authority of State medicaid fraud control units to 
investigate and prosecute fraud in connection with Federal health care 
programs and abuse of residents of board and care facilities; to the 
Committee on Finance.


               the senior citizen protection act of 1998

  Mr. BAUCUS. Mr. President, today I rise to introduce the Senior 
Citizen Protection Act of 1998. The legislation aims to protect our 
nation's seniors from patient and elder abuse. The bill also protects 
our federal health care programs, most notably Medicare, from fraud.
  In the past two years, we have made great strides against fraud and 
abuse by passing new initiatives. These initiatives include closing 
loopholes, improving coordination between Federal, State, and local law 
enforcement programs, and enhancing the powers of the Inspector General 
of the Department of Health and Human Services to combat fraud and 
recover lost money.
  These measures are helping, but there is another vision which I think 
will help us stay ahead of those who endlessly scheme to defraud our 
health care programs. The Senior Citizen Protection Act deputizes 
Medicaid investigators and enables them to weed out fraud and abuse in 
our federal health program.
  Currently, when a Medicaid Fraud Control Unit investigates a state 
Medicaid fraud case and finds a similar violation in Medicare, the Unit 
cannot investigate the Medicare infraction. Common sense will tell you 
that an unscrupulous actor defrauding Medicaid will likely do the same 
to federal health programs.
  In Montana, for example, the Medicaid Fraud Control Unit routinely 
finds co-existing cases of Medicaid and Medicare fraud in patient 
records. While the Unit has the documents right in front of them, they 
can not pursue the Medicare abuses.
  Federal authorities must conduct a new and separate investigation. 
Unfortunately, these violations may be too small to justify a federal 
investigation. The majority of health care fraud recoveries, 62%, are 
more than a million dollars. Even more striking, only 6% of federal 
fraud recoveries are in an amount lower than $100,000. Thus, the 
Federal Government is doing a good job of weeding out the big actors in 
the anti-fraud war, but the smaller actors--which still cost money--
continue to ride scot-free.
  That is where our legislation can help. If a fraud Unit is 
investigating a fraudulent doctor, for example, and finds some Medicare 
claims that look false, currently the investigator has to call the 
Inspector General's office and report their suspicions.
  In many cases, however, they hear back from Washington that the 
claims may be fraudulent, but the fraud is not

[[Page S4529]]

widespread enough to justify the expense of a federal investigation. 
Under our legislation, the Units will now be able to wrap the Medicare 
case into their own investigation and the Federal Government will be 
able to continue spending their resources on larger fraud operations.
  The Senior Citizen Protection Act allows state Fraud Control Units to 
investigate federal violations which come to their attention during an 
existing state Medicaid investigation. By giving the Units this 
discreet authority, we can take another step toward reducing fraud and 
abuse.
  While most fraud cases are the result of overbilling, false billing, 
or a provider performing unnecessary services, almost 25% of health 
care fraud cases are due to poor quality of care or care not provided. 
And that is when these problems cross over from health care fraud to 
actual patient abuse and neglect. It alarms all of us when we hear 
stories of older individuals being harmed by unscrupulous persons. What 
upsets me so much about elderly abuse is how vulnerable these victims 
are, especially since they depend so much on their health care 
providers for actual daily activities.
  Some Senators may have heard about the egregious case in Arizona 
where two defendants pled guilty to three counts of aggravated assault 
for sexually assaulting, intimidating and abusing patients. Their 
crimes included spitting at and kicking patients, and threatening to 
give a pill to a patient so he would never wake up. Some patients were 
so afraid they would not eat or drink. This is a modern tragedy.
  Other stories include incidents of physical abuse, verbal ridicule 
and mockery, and neglect, such as depriving patients of food, water and 
the opportunity for communication.
  Under current law, state Medicaid Fraud Control Units can only 
investigate and prosecute cases of elder abuse in state-funded 
facilities. However, more and more seniors are moving into assisted 
living and residential treatment settings that receive no state funds. 
Let me be clear: I support this trend, as it gives seniors more choices 
about the type of long-term care they receive. I am concerned, however, 
that assisted living facilities have little oversight to prevent 
patient neglect and abuse. Local authorities often lack the resources 
and skill to investigate health care cases.
  In Montana, our state Medicaid Fraud Control Unit routinely receives 
calls from local law enforcement agencies, local public health 
departments, and even Adult Protective Services requesting assistance 
with elder abuse cases. However, the Fraud Unit's hands are tied; they 
lack the jurisdictional authority to offer help.
  The Senior Citizen Protection Act will enable state Medicaid Fraud 
Control Units to investigate cases of patient abuse and neglect in 
residential facilities that do not receive state reimbursement. 
Medicaid investigators have the experience and expertise to assist 
local authorities with this job. Allowing the Medicaid Fraud Control 
Units to lend their expertise to cases in non-Medicaid facilities makes 
good sense and is right for our seniors.
  Mr. REID. Mr. President, I rise in support of S. 2040 the Senior 
Citizens Protection Act introduced by Senator Baucus earlier this 
morning.
  I am pleased to be an original cosponsor on this important 
legislation.
  There are 47 federally certified Medicaid Fraud Control Units across 
the country. Since the program began in 1978, more than 8,000 cases 
have been prosecuted. They do an excellent job.
  Millions of dollars have been returned as a result of their work.
  The ``Senior Citizens Protection Act of 1998'' makes two very simple 
changes to Medicaid Fraud Control Unit authority.
  First it gives MFCU's the authority to investigate violations in our 
federal health programs--primarily Medicare in addition to their 
current authority to investigate violations in Medicaid.
  Secondly, the bill would enable MFCU's to investigate patient abuse 
and neglect in residential health care facilities that do not receive 
Medicaid reimbursement.
  In short the bill has two goals: to stop health care fraud and to 
protect vulnerable seniors.
  As the face of long-term care changes, local authorities need the 
resources to investigate claims of patient and elder abuse.
  Rather than create new bureaucracies, this bill allows us to build 
upon the expertise of an existing entity--the state Medicaid Fraud 
Control Units.
  During two Aging Committee field hearings that I held in Las Vegas 
and Reno in January 1998, I heard first hand from the Nevada Attorney 
General, Frankie Sue Del Papa, how important this legislation was.
  She made it very clear to me that her Medicaid Fraud Control Unit has 
the expertise to investigate these cases. They simply need the 
authority.
  The MFCU's have the know how and experience to protect seniors in 
residential health care facilities. They merely lack the authority to 
get involved in non-Medicaid cases.
  This legislation will give them the needed authority. That is why 
this bill is endorsed by the National Association of Attorneys General, 
the Department of Justice, the American Association of Retired Persons 
and the Department of Health and Human Services Office of the Inspector 
General.
  Simply put, it is the right thing to do.
  It is unfortunate that when MFCU investigators involved in a case of 
Medicaid fraud discover evidence that this fraud may also be happening 
in the Medicare program, or other federally funded health care 
programs, they are restricted from taking action. This bill will change 
that.
  Under current law, the MFCU can only investigate patient abuse in 
medical facilities which receive Medicaid funds.
  In 1996 and 1997, the Nevada MFCU received 120 referrals but only 
opened 20 investigations due in part to limited jurisdiction.
  Although many of these cases are referred to local law enforcement, 
they may never be criminally investigated or prosecuted due to lack of 
expertise or available resources.
  State MFCUs are able to conduct these investigations and this bill 
will give them the needed authority.
  In Nevada 47 nursing homes and 54 adult group homes receive Medicaid 
funding.
  When abuse or neglect occurs in such facilities, the state MFCU can 
investigate.
  However, we also have approximately 265 residential facilities for 
groups and 321 registered homes which could fall within the definition 
of ``board and care facilities'' set forth in this bill.
  With the passage of this bill, seniors and other residents in these 
facilities would be protected regardless of whether the facility 
receives Medicaid funding or not.
  This bill would give the state MFCU the authority to investigate 
allegations of abuse and neglect in these facilities.
  As we collectively strive to reduce fraud and abuse in our Medicare 
and Medicaid programs, we cannot overlook any opportunity to make a 
difference.
  This bill is a welcome weapon in our arsenal to fight abuse.
  I commend Senators Baucus of Montana and Graham of Florida for their 
sponsorship of this bill and Senators Mikulski, Grassley, Johnson, and 
Breaux for their original cosponsorship of this important legislation.
  We need all the ammunition possible in the war against health care 
fraud and in assuring the protection of our nation's most vulnerable 
seniors in the spectrum of long-term care facilities.
  The bill introduced by my colleagues today is a major step in the 
right direction.
  I am pleased to join them in sponsoring this important legislation.
  Ms. MIKULSKI. Mr. President, I am pleased to be an original cosponsor 
of the Senior Citizens Protection Act of 1998, introduced by Senator 
Baucus. I support this legislation for two reasons--it fights fraud and 
protects seniors.
  Fraud and abuse pose a serious threat to Medicare and Medicaid. We 
cannot afford to tolerate any more abuse of the system. The job of 
Medicaid Fraud Control Units (MFCUs) is to investigate and prosecute 
Medicaid fraud in state programs. MFCUs have prosecuted thousands of 
cases and recovered hundreds of thousands of Medicaid dollars. Every 
dollar saved by MFCUs is another dollar we can use to provide quality 
service to those who need it.

[[Page S4530]]

  This legislation expands the authority of Medicaid Fraud Control 
Units in two ways. It allows MFCUs to investigate federal fraud 
violations discovered during a state Medicaid investigation. Currently, 
MFCUs cannot investigate Medicare fraud or other federal fraud 
violations. Under the Senior Citizens Protection Act, MFCUs will be 
able to investigate federal fraud, and return recovered funds to the 
federal government.
  I am firmly committed to protecting seniors from elder abuse. This 
legislation protects seniors by authorizing to MFCUs to investigate 
patient abuse in residential health care facilities that do not receive 
Medicaid reimbursement. The number of residential facilities is 
growing, but local authorities often lack the resources to investigate 
elder abuse. MFCUs are already investigating elder abuse in facilities 
that receive Medicaid funding. But under the Senior Citizens Protection 
Act, MFCUs will be able to protect all of our senior citizens living in 
residential facilities.
  I want to let those who depend on Medicaid and Medicare know that we 
are fighting to stop fraud and waste. We have done an outstanding job 
in protecting Medicaid-covered seniors from fraud and abuse. It is now 
time to extend that protection to all of our senior citizens.
                                 ______