[Congressional Record Volume 155, Number 160 (Friday, October 30, 2009)]
[Senate]
[Pages S10949-S10951]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                           HEALTH CARE REFORM

  Mr. LeMIEUX. Mr. President, I rise to talk about issues very similar 
to those of my friend from Texas and echo his concerns about the 
current proposal for health care. We found out yesterday the proposal 
that was put forth by the Speaker of the House is nearly 2,000 pages. 
It is a $1 trillion proposal. That is $\1/2\ billion per page. It is 
sort of staggering to think about.
  When I came to Washington, just a couple months ago, appointed by my 
Governor--Charlie Crist of Florida--it was my cause to come and be a 
problem solver, to help work on issues that both Republicans and 
Democrats could work on together. I learned from Gov. Charlie Crist 
that there are lots of issues we can disagree about principally, but 
there are plenty of issues

[[Page S10950]]

we can work on together and do things that are right for the people. 
That may not be in vogue in Washington, DC. It may not be in vogue to 
try to find issues--the low-hanging fruit--we can work on together to 
solve problems, but it is something I wish to pursue.
  Additionally, when I came to Washington, I recognized--and I spoke 
about this last week in my first address in this August body--there are 
lots of times most folks in Congress would like to discuss grand new 
plans, grand new ideas for the future of this country. That is exciting 
to talk about--a new program or a new administration, more government 
employees working on a new program, perhaps, in some new government 
building. But I don't have a passion necessarily for following up on 
those great ideas for future plans. I have a passion for helping us do 
better what we already do. Oftentimes, in government, that is not the 
case. We spend billions, trillions of dollars a year on existing 
government programs, but many times we don't do it effectively and 
efficiently. If we spent as much time caring about the money we are 
spending now, as opposed to the money some in this Chamber want to 
spend, I suspect we could find plenty of money to either return to the 
people or to find money for these new programs.
  Today, I wish to talk about just such an idea, an idea to recover 
some of the waste, fraud, and abuse that is currently happening in our 
system of government. We know in our current provision of health care--
in Medicare and Medicaid--there is tremendous waste, fraud, and abuse. 
Estimates are that some $60 billion to a staggering $226 billion a year 
to waste, fraud, and abuse.
  This health care proposal that was put forth by Speaker Pelosi and 
that we are discussing in the Senate, just for comparison purposes, is 
$1 trillion over 10 years. I think anybody who has watched the 
government knows that if you estimate something is going to cost $1 
trillion, it is going to be a whole lot more than that when it actually 
gets implemented because we don't do much in government that comes in 
under our estimates. Most times, almost every time, it is a lot more 
than is estimated. But let us compare these numbers, $1 trillion over 
10 years. That is about $100 billion a year. We may be wasting $226 
billion a year.
  If we captured just half of that, we might be able to pay for this 
program. Better still, we could take those dollars we are wasting in 
fraud and abuse and we could put them back into the Medicare Program to 
pay for health care for seniors. Wouldn't that be a good idea? Because 
the estimates tell us that in 8 years we are going to be in a situation 
in Medicare where we are going to be in a deficit. We are going to be 
taking in less money than we need to spend. Workers will be paying in 
less than retirees need for their health care. We will have to, as the 
Federal Government, shore up Medicare certainly at that point. So why 
don't we concentrate now, while we can, on an issue Democrats and 
Republicans can agree upon, which is trying to stop waste, fraud, and 
abuse.
  Yesterday, I had the honor of filing my first bill in the Senate--S. 
2128--and I wish to talk to the Senate and the American people about 
that bill. S. 2128 is the Prevent Health Care Fraud Act of 2009. What 
this bill simply will do is try to go after the waste in the health 
care system the government currently runs. It is estimated that $1 out 
of every $7 we spend on health care for seniors is captured by 
criminals or is wasted and is not going to help seniors--$1 out of 
every $7. That is where we get to that number of potentially $226 
billion a year.
  I have a lot of experience in this. Before coming to the Senate, I 
had an opportunity to serve as the deputy attorney general in Florida 
and to run--under then-attorney general Charlie Crist--an office of 
about 400 lawyers. Within that office, we had a Medicaid fraud control 
unit where we focused on fraud in Medicaid. We were able to recover 
$100 million a year--just in Florida--by stepping up enforcement 
actions to capture bad guys who were taking dollars out of the system. 
What I wish to try to do with this new act, in S. 2128--the Prevent 
Health Care Fraud Act of 2009--is not just go after these bad guys once 
we have figured out they have taken the money but to prevent them from 
getting the money in the first place.
  The American people would be shocked to know how little we do to 
prevent health care fraud. You might expect, sitting at home in Orlando 
or wherever you are in the country listening to this address today, 
that we have a very comprehensive system to stop health care fraud; 
that if the government is spending billions of dollars, trillions of 
dollars over time on health care, that we would have hundreds and 
thousands of people who would be working to stop health care fraud; 
that we would have sophisticated computer models that stopped health 
care fraud before it happened. That is simply not true.
  I introduced this bill yesterday, and I am speaking about it today, 
to help try to stop this fraud before it starts. My goal is to be a 
problem solver in Washington, to work on issues everybody can agree 
upon. Let me tell you about what S. 2128 does. It does three things, 
basically. We are going to create, within the Department of Health and 
Human Services, a Deputy Secretary who will be the chief health care 
fraud prevention officer of the United States. That individual will be 
in a No. 2 role in that agency. That person will report directly to the 
Secretary and will be nominated by the President of the United States. 
That Deputy Secretary will not have seven different jobs. He or she 
will have one job--to prevent health care fraud. If that Deputy 
Secretary does not do his or her job, they will come to the Senate and 
the House of Representatives and be called on the carpet. This chief 
health care fraud prevention officer of the United States is going to 
run a division that is going to work every day to stop this health care 
fraud before it starts.

  How are they going to do it? Oftentimes, the private sector gives us 
a model that we can use and we can copy in the government to help us 
prevent health care fraud or anything we do in government, to do it 
more efficiently and more effectively. So what model is out there to 
prevent fraud that is being used every day and that affects all our 
lives, that stops fraud before it starts? That model is the credit card 
business, a business that is roughly the same size as the health care 
business.
  A couple of trillion dollars a year passes through the exchange of 
credit cards for the purchase of goods and services. The health care 
industry is a multitrillion-dollar-a-year industry as well. The level 
of fraud in the health care industry is $1 out of every $7. The 
incidence of fraud in the credit card industry is 7 cents for every 
$100--$1 out of every $7 versus 7 cents for every $100. How do they do 
it? Well, we all have had this experience. You use your credit card to 
purchase something and then a couple minutes later you get a phone call 
or e-mail which asks: Did you authorize the purchase that just happened 
with your credit card?
  This just happened to me a week ago. I went to buy a television, in 
Washington, DC, at Best Buy. I have my family here so they can be close 
to me during my time in the Senate, and we have to have a television. 
So I go to Best Buy and use my credit card. I walk out the door and my 
BlackBerry vibrates. There is an e-mail from my credit card company 
asking: Did you authorize the purchase of a television at Best Buy? Why 
did that happen? They have a computer modeling predictive system that 
says this is a questionable transaction. George lives in Tallahassee, 
FL; someone is using his credit card to buy a television--which is 
something that is probably bought a lot of times on a stolen credit 
card--something is up. The computer--no person does this, this has been 
programmed--goes into action and I get an e-mail. That transaction is 
not authorized for payment until I call my credit card company and tell 
them, yes, I actually authorized that purchase.
  Why can't we do the same thing the credit card companies are doing 
for health care? Why can't we use a predictive modeling system that 
says a health care claim is not going to be paid when a red flag comes 
up? Right now we are on a pay-and-chase system. We pay these people who 
provide health care, allegedly--many of whom are not providing health 
care because a good portion of them are criminals, frankly--and then we 
try to go after them to enforce the law, and we barely

[[Page S10951]]

ever capture the money back. We capture some but not near enough. If we 
put this model in place, it stops the fraud before it happens.
  S. 2128--the Prevent Health Care Fraud Act of 2009--would put this 
predictive modeling system in. The Federal Government would have to go 
out and hire folks to do it. We would have a competitively bid process. 
It is no different than what we do in other parts of the government. In 
the Defense Department, we go through a bunch of checks before there is 
an acquisition for the Defense Department. Why can't we put this 
predictive modeling system over in health care to use real-time data to 
stop these fraudulent transactions before they happen?
  According to Harvard University Professor Malcom Sparrow, the credit 
card industry establishes benchmarks for acceptable business risk and 
their threshold is one-tenth of 1 percent. By contrast, fraud losses in 
the health care business run from 3 to 14 percent. That is 100 times 
the acceptable business risk.
  Another thing this bill does is it requires background checks for all 
health care providers. If you are supposedly providing health care, 
whether you are providing a wheelchair or a doctor providing actual 
health care services--someone who is a physician's assistant or whoever 
it may be--if those folks are being reimbursed by the Federal 
Government, getting paid for the health care they are providing, they 
should not be criminals. You might think that right now we are doing 
background checks on all these health care providers, but we are not.
  I know this, specifically, because Florida, unfortunately, is ground 
zero for health care fraud. We have tremendous problems in Florida, 
especially the southeast part of Florida, where I am from--Fort 
Lauderdale, Miami-Dade County--with health care fraud.
  Let me cite some examples.
  Mr. President, ``60 Minutes,'' last week, aired a special on this. 
They talked about the rampant fraud in south Florida. One of the 
perpetrators was responsible for $20 million of health care fraud 
alone, and he said: We get a Medicare book of codes and our bidder 
tells us which ones to use and we run the codes. So they get one 
wheelchair and they sell it a thousand times and get reimbursed a 
thousand times for it. There is no computer modeling system that puts 
the red flag up, such as there would be on your credit card, that says: 
Stop that; wait a minute; after the third wheelchair is sold in 60 
seconds, maybe we should not pay this guy's claim.
  It has gotten so easy to steal money from the Federal Government that 
organized crime has gotten involved. There have been stories of a 
Russian-Armenian organized crime ring that defrauded Medicare by $20 
million, and they said it was easier than trying to be involved in the 
illicit drug business because there was no one going after them.
  I wish to take a moment to applaud my colleague from Delaware, 
Senator Kaufman, who just introduced some legislation called the Health 
Care Fraud Enforcement Act of 2009 to increase the penalties for health 
care fraud.
  I think that is great. We should be doing that. But in combination 
with that, we should do what we propose in S. 2128, which is to stop 
the fraud before it happens. These instances of fraud across the 
country are rampant.
  I will give you another example. South Florida is home to 8 percent 
of the Nation's AIDS patients, but 72 percent of Federal AIDS 
medication payments are paid in South Florida. That is 72 percent, when 
we only have 8 percent of the patients. Why is this happening? These 
medications for AIDS are extremely expensive. Some bad guy runs the 
code all day and says: I have given this many injections of AIDS 
medication at $2,500 a pop; runs 1,000 codes and we pay them. We pay 
them.
  It makes no sense to me. So we have had big disagreements about how 
we are going to solve health care, how we are going to provide more 
affordable health care to our people in this country, how we are going 
to provide more access to health care.
  But we certainly can agree we should run whatever program we have 
efficiently and effectively. We can certainly agree we should not have 
waste, fraud, and abuse. If we can reduce the $60 billion to more than 
$200 billion in fraud a year by simply putting somebody in charge of 
health care fraud prevention, put predictive modeling in such as we 
have in the credit card industry, and not let people be health care 
providers unless they have a background check and, if they are a 
criminal, not let them provide health care, we can save billions of 
dollars.
  Those dollars can go back into Medicare, which is running at 
deficits. As I said when I opened my remarks today, it is very much in 
vogue in Washington to propose brandnew plans. I understand that. But 
we need to be focused and have as much zeal about brandnew plans as 
running the programs we have efficiently and effectively.
  I hope my colleagues will join me in supporting this piece of 
legislation, S. 2128, the Prevent Health Care Fraud Act of 2009.
  I yield the floor and I suggest the absence of a quorum.
  The PRESIDING OFFICER (Mr. Whitehouse). The clerk will call the roll.
  The legislative clerk proceeded to call the roll.
  Mr. SESSIONS. 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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