[Congressional Record Volume 156, Number 12 (Thursday, January 28, 2010)]
[Senate]
[Pages S345-S346]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. GRASSLEY:
  S. 2964. A bill to amend title XVIII, XIX, and XXI of the Social 
Security Act to prevent fraud, waste, and abuse under Medicare, 
Medicaid, and CHIP, and for other purposes; to the Committee on 
Finance.
  Mr. GRASSLEY. Mr. President, in 2009 the Medicare, Medicaid and CHIP 
programs accounted for over $800 billion of the $2.3 trillion spent on 
health care in the U.S. Together, these programs constitute around 35 
percent of national health spending. With so much taxpayer money at 
stake, it is no surprise that all this spending brings crooks, scam 
artists and even organized crime out of the woodwork.
  Low estimates are that fraudsters steal $60 billion from the Medicare 
and Medicaid programs every year. As Federal health care spending 
continues to skyrocket, so will the dollars lost to fraud, waste and 
abuse.
  This is a crime against not only the taxpayer, but against each and 
every beneficiary who depends on these programs for their health care. 
The examples of fraud are all around us. In a 60 Minutes segment late 
last year, we saw a medical supply company that billed Medicare $2 
million last July--despite being empty and having apparently no staff.
  One man interviewed said he was waking up every day making $20,000-
$40,000. Every single day. He said it was like winning the lottery, and 
you and me and every taxpayer were footing the bill. He was running a 
fake medical supply company that didn't actually sell any medical 
equipment to anyone. He says he stole at least $20 million from 
Medicare. He said it was, ``real easy.''
  This must change.
  I don't think Members on either side of the aisle dispute this. Back 
when health care reform was a bipartisan endeavor, I developed a set of 
legislative proposals with Senator Baucus to combat fraud, waste and 
abuse. These proposals are in the bill that the Finance Committee 
reported as well as the health care reform bill that the Senate passed 
late last year. And these provisions did not draw opposition from 
either side of the aisle. Tackling fraud, waste and abuse in health 
care is one of the areas where there is widespread agreement.
  That is why I am here today to introduce the Strengthening Program 
Integrity and Accountability in Health Care Act. This legislation 
includes the critical measures that I developed on a bipartisan basis. 
This bill also includes legislation and amendments I have subsequently 
introduced to strengthen these proposals to address fraud, waste and 
abuse.

  They are designed to deter, detect and prevent those that would steal 
from Federal health care programs, to assist those tasked with catching 
these criminals, and to protect taxpayer dollars. These commonsense 
changes will go a long way in helping to make sure Medicare, Medicaid 
and CHIP dollars are going to bona fide providers, instead of 
fraudsters set on scamming the system.
  This legislation would make it harder for fraudsters to enroll in 
Federal health programs as providers and bilk the system. This includes 
requiring meaningful screening of health care providers and suppliers. 
Additional tools would also be provided to prevent fraud, waste and 
abuse including enhanced oversight measures, disclosure requirements, 
authority to impose enrollment moratoriums and requirements for 
developing compliance programs.
  This bill would impose additional requirements on providers and 
suppliers to ensure that bona fide providers are billing Federal health 
programs for bona fide items and services. This includes providing 
documentation or performing a face-to-face evaluation before certifying 
a beneficiary's eligibility for an item or service.
  It would also improve Federal monitoring for fraud, waste and abuse 
by requiring better data sharing and data

[[Page S346]]

access across the Federal government. Government agencies would be able 
to share information with each other in an effort to identify crooks in 
the system promptly. It would also create a national clearinghouse of 
information so we can better detect and prevent and thereby deter 
medical identity theft. Again, this is about the Federal Government 
sharing information it already has in ways that protect the Taxpayer 
and work against those defrauding the system and hopefully deter those 
who are thinking about stealing from you.
  The legislation takes several steps to end the current ``pay and 
chase'' model of Federal health care spending. It takes the commonsense 
approach of allowing the government to withhold taxpayer dollars from 
those under investigation for health care fraud.
  It would change Federal laws that require Medicare to pay providers 
quickly, regardless of the risk of fraud, waste, or abuse. Under 
current law, the government is required to make payment for a ``clean'' 
claim within 14 to 30 days before interest accrues on the claim. That 
is not enough time for the limited number of Medicare auditors to 
determine if the claim is legitimate before the payment has to be made. 
The result is that this ``prompt payment rule'' requires that Medicare 
pay fraudsters first, and ask questions later.
  This requirement doesn't make any sense. This bill would give the 
Secretary of Health and Human Services the authority to ask questions 
first and then and only then to make the payment if the health care 
provider and the payment for services check out. The Secretary would 
also be required to suspend payments pending the investigation of 
credible allegations of fraud against the provider or supplier.
  This legislation would also increase funding for those fighting 
health care fraud. Study after study has shown that every dollar spent 
fighting health care fraud is repaid multiple times over in funds 
recovered and fraud prevented. This is a good investment for the 
taxpayer and bad news for health care fraudsters.
  This bill would provide powerful disincentives for those that would 
rob the taxpayer through health care fraud. It would better arm those 
fighting fraud with tools to catch and prosecute fraudsters. It also 
would make the consequences for committing health care fraud more 
meaningful by increasing civil monetary penalties and expanding the 
types of acts and omissions that would be subject to civil monetary 
penalties and exclusion from Federal health programs.
  This legislation would also strengthen the government's most powerful 
tool for preventing and recovering taxpayer dollars lost to fraud, the 
False Claims Act. It also ensures that courageous whistleblowers that 
come forward to speak up against fraud and file False Claims Act cases 
are protected from retaliation by their employers.
  These changes would go a long way to deter those who would defraud 
our health care programs. It also would provide greater protections to 
the taxpayer. In these difficult economic times, we have got to do 
everything we can to protect taxpayer dollars and the resources of 
health care programs on which so many Americans depend.
                                 ______