[Congressional Record Volume 161, Number 154 (Wednesday, October 21, 2015)]
[Senate]
[Pages S7370-S7371]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                           WASTEFUL SPENDING

  Mr. COATS. Mr. President, I return to the floor this week for my 24th 
edition of ``Waste of the Week.'' I have been coming down every week 
that Congress has been in session during this cycle talking about 
waste, fraud, and abuse of hard-earned taxpayer dollars. This is the 
24th edition, and today I want to highlight improper Medicare payments.
  We all know that Medicare is important to our older citizens, of 
which I am one. Tens of millions of Americans depend on Medicare for 
their health care coverage, and we all know that we have the 
responsibility here in this body to preserve these important health 
benefits for those who depend on them. Preserving these benefits is 
protecting Medicare from waste, fraud, and abuse. Unfortunately, 
throughout the history of Medicare, it has been plagued by improper 
payments, and it is shocking to hear the numbers.
  The Government Accountability Office has reported that improper 
Medicare payments totaled nearly $60 billion in 2014 alone, and over 
the last 10 years, there has been $336 billion of improper payments in 
the Medicare system. This figure does not even include improper 
payments for certain Medicare programs whose record keeping does not 
date back that far.
  Examples of improper Medicare payments include services that are not 
medically necessary, duplicative billing for services by providers, 
ineligible practice locations, and spending on services that actually 
never took place. Yes, actions that never took place have been billed 
to the government. It wasn't discovered until later that those 
reimbursements were improper, and it is rampant. This is taking money 
out of American people's pockets. It is also denying those who have 
Medicare the coverage that they are entitled to under the program. It 
is driving Medicare down a road to insolvency that we are going to have 
to deal with, and I think we should have been dealing with it over the 
past few years.
  Since we can't summon the political will--to my great distress--to 
recognize the fact that Medicare is careening toward insolvency at some 
point, which will result in significantly cutting benefits for current 
members receiving benefits under Medicare or require massive tax 
increases to cover the deficit, one of the areas we can deal with now 
is to at least address those issues where we know that abuse has taken 
place.
  This is the 24th time I have come down to the floor to talk about 
this issue, and I have this chart with a thermometer on it to 
demonstrate the spending that has taken place. We wanted to reach the 
goal of defining $100 billion of waste, fraud, and abuse. Well, we shot 
way past that. I mean, we just can't catch up with it. These are 
matters that have been accounted for by the Government Accountability 
Office. This is not something that Republicans are just making up or 
drawing from anecdotal items that appear in the paper or are raised on 
the talk shows. These are examples of what we have already documented.
  Every once in a while when I come down here, I could talk about the 
$60 billion, and we could add $60 billion to our climbing 
accountability of the total of waste, fraud, and abuse. But every 
fourth or fifth time I like to address something that is so egregious 
that it draws the public attention to say that we ought to look into 
this or to press their elected representatives to do something about 
this matter and say: Can you believe we are wasting money on something 
as frivolous as this?
  The Washington Post recently said in an editorial about improper 
Federal payments: ``Every misspent dollar lining an undeserving pocket 
is a dollar not available for those who need the help.''
  Now, from time, as I have said, I try to bring up something that 
catches the

[[Page S7371]]

public interest. We have talked about Federal grants that were used to 
prove that massaging of rabbits--using rabbits as an example--makes 
them feel better after a strenuous workout. I think most of us could 
have figured that out without having to spend some $300,000. I think it 
was even more than that--as a grant. Somebody came to the conclusion 
that this would be a worthy project and a good use of taxpayer dollars. 
That got a lot of attention.
  Today I will talk about improper payments that were made to ambulance 
suppliers. Medicare coverage allows ambulance transports when a 
patient's medical condition at the time of transport is such that any 
other means of transportation would endanger the patient's health.
  If something happens with the patient at home where the spouse 
decides to drive the patient to the hospital but then comes to the 
conclusion that, no, that could potentially endanger the person's 
health further and decides to call 911 instead for an ambulance and 
they decide they need to transport this person so he or she has medical 
care on the way to the hospital, then a person is eligible under 
Medicare for transportation by the ambulance if they can prove that is 
necessary. The transport has to be for a patient who has a condition 
that is covered under Medicare in order to get a ride home from the 
hospital. So the patient gets transferred both to the medical provider, 
usually the hospital, and is then transported back to his or her house 
if it is medically necessary.
  As a further requirement to qualify for the reimbursement, the 
provider who is providing the ambulance service has to meet specific 
qualifications in addition to what I just said. It can only be 
transportation that takes you to a hospital, a skilled nursing facility 
or a dialysis facility for certain patients, and then the ambulance can 
take them back home after they have received the care. Unfortunately, 
even with these guidelines, fraud is taking place and millions of 
taxpayer dollars are being wasted.
  A recent report by the inspector general from the Department of 
Health and Human Services, which oversees Medicare, found that Medicare 
made $207 million in questionable ambulance service payments during the 
first half of 2012. Shockingly, these payments include $30 million 
where Medicare paid for transportation even though the beneficiaries 
may not have received any Medicare services at either the time of 
pickup or dropoff or at the locations or anywhere else. Thus, we are 
talking about millions of taxpayer dollars that may have been spent on 
phantom transports.
  These improper charges were made and sent to Washington and the 
ambulance services were reimbursed.
  Can you imagine an ambulance with its lights flashing and going down 
the road on its way to the hospital while cars pull over to the side of 
the road, as we are required to do, because presumably the person in 
the ambulance is in danger and their health is at risk? They need to 
get them to the hospital or maybe the person needs dialysis and doesn't 
have means of transportation. No, these may be empty ambulances with 
their lights flashing--cars pulling over. Then they bill the government 
and are getting reimbursements for the trip to and from the hospital. 
There has been $207 million of documented improper billing for these 
services.
  Let me give one example. One of those services is a Pennsylvania 
company that fraudulently billed Medicare $3.6 million for transports, 
and the supplier recruited patients that did not require any transport. 
They made a deal with them. They said: Look, we are going to use your 
name to submit the billing for reimbursement. We know that you don't 
need the transportation for anything, but we need to document this so 
we can get our money back. So what we will do is give you part of the 
reimbursement. We will pay you some of the money that we get if you 
will allow us to use your name and identity--maybe your Social Security 
number or Medicare card number--and you will be in on the deal. So if 
you get a call from an inspector or somebody trying to verify this 
reimbursement, say: Yeah, I had to go to the hospital or dialysis, and 
yes, that was a legitimate charge. This company was finally identified 
after charging $3.6 million for transportation that did not meet 
Medicare coverage requirements.
  You might say: OK, that is one company charged with fraud. You read 
about that in the paper. The inspector general found that one out of 
every five suppliers had a questionable billing practice, and that is 
how it totals up to $207 million. Clearly, this is a problem that has 
to be addressed, and if we address this problem, we can save the 
taxpayer money or we can at least make sure that this money is going to 
cover the necessary medical treatment for those under Medicare. With 
10,000 retirees entering the Medicare program every day, we need to 
slow down the movement toward insolvency. We need to deal with that 
here in Congress. We should have been dealing with this issue 
before. So by putting these proper safeguards in place, over $207 
million in questionable ambulance services could be eliminated and 
taxpayers' dollars could be saved.

  This is a small addition to an ever-growing list of savings to the 
taxpayer if we can eliminate waste, fraud, and abuse.
  I will bring up my chart. As I said before, we used to have a 
thermometer here to show this, how we were creeping up, and it went so 
high, it started going to the ceiling. We now have a total of 
$117,141,182,855 and change in terms of waste, fraud, and abuse. We 
will be back next week for the next installment of many more to come.
  Mr. President, with that, I yield the floor.
  The PRESIDING OFFICER. The Senator from Georgia.

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