[Congressional Record (Bound Edition), Volume 148 (2002), Part 14]
[Senate]
[Pages 18885-18886]
[From the U.S. Government Publishing Office, www.gpo.gov]




       MEDICARE APPEALS, REGULATORY AND CONTRACTING IMPROVEMENTS

  Mr. GRASSLEY. Mr. President, I want to take a few minutes to discuss 
a provision in the Beneficiary Access to Care and Medicare Equity Act I 
introduced yesterday with Senator Baucus.
  The core of our bill, as the short title indicates, ensures 
beneficiary access to care and improves equity in Medicare payments. 
But the bill also makes important other improvements to the Medicare 
program that go beyond payment policy and beneficiary improvements.
  Chief among those is regulatory relief for providers.
  Every day, in cities and towns across Iowa, health care providers 
treat the sick, restore them to health, and work to prevent further 
illness. Iowa's proportion of older adults in the population exceeds 
that of the United States as a whole. In fact, we rank second in the 
Nation in our percentage of persons aged 85 and older.
  Simply put, the Medicare program means a great deal to Iowans, not 
only from a beneficiary perspective but also from a provider 
perspective. Health care providers in Iowa rely on the Medicare program 
for much of their business.
  I have had extensive conversations with many Iowa health care 
providers and workers, and a complaint I have heard over and over is 
that the Medicare program is too bureaucratic. Too much time is spent 
on paperwork instead of treating patients. Rules coming out of 
Washington are confusing and contradictory. Doctors and nurses receive 
one answer to a question from their Medicare contractor and a different 
answer from Medicare headquarters in Baltimore.
  Now, don't get me wrong. My position on the sin of Medicare waste, 
fraud, and abuse has not changed. As a watchdog of the taxpayer dollar, 
I firmly believe in asking health care providers to account for the 
money they receive from the government. Taxpayer dollars must be spent 
responsibly. However, when honest providers are unable to get straight 
answers from the government, frustration and inefficiency can result. 
The outcome is a health care program that is not serving beneficiaries 
or taxpayers as well as it could. So I am proud that this legislation 
takes steps to treat some of these bureaucratic ills afflicting 
Medicare.
  Based on provisions in a bill introduced last year by myself and 
Senator Baucus, along with Senators Murkowski and Kerry, the 
Beneficiary Access to Care and Medicare Equity Act offers additional 
appeal rights for providers, mandates enhanced provider education, and 
ensures that providers receive straight answers from the Centers for 
Medicare and Medicaid Services, CMS.
  Importantly, our legislation reforms the way Medicare contracts with 
the private companies that process and pay claims. Today, CMS is 
stymied by outdated guidelines that fail to recognize efficiency and 
quality in contractor performance. Today's system is also not 
competitive. Our legislation brings

[[Page 18886]]

competition into the program so that the best available contractors, in 
terms of quality and efficiency, will serve it. The bill provides 
incentives for contractors to give timely and accurate information to 
beneficiaries and providers.
  For Medicare contractor reform to succeed, however, contractors need 
protection from unlimited civil liability in carrying out the payments, 
provider services, and beneficiary services functions expected of them.
  The bill I have just introduced would therefore continue the past 
policy of limiting the liability of certifying and disbursing officers, 
and the Medicare administrative contractors for whom those officers 
serve, with respect to certain payments. In addition, the language 
contained in Section 621 clarifies that Medicare administrative 
contractors are not liable for inadvertent billing errors but, as in 
the past, are liable for all damages resulting from reckless disregard 
or intent to defraud the United States.
  Importantly, the reckless disregard standard is the same as the 
standard under the False Claims Act, a 150-year-old Federal law that I 
updated in 1986 and that has had unmatched success in fighting fraud 
and abuse in Federal programs like Medicare. The False Claims Act, 31 
U.S.C. Sections 3729-3733, applies to Medicare fiscal intermediaries 
and carriers under current law and has been used effectively by 
whistleblowers and the Department of Justice to uncover and penalize 
fraud against the program by some intermediaries and carriers.
  This specially calibrated version of reckless disregard balances the 
practical need to shelter Medicare administrative contractors from 
frivolous civil litigation, with the Medicare program's interest in 
protecting itself from contractor fraud. This legislation makes it 
clear that the False Claims Act continues, as in the past, to remain 
available as a remedy for fraud against Medicare by certifying 
officers, disbursing officers, and Medicare administrative contractors 
alike and that, among other things, the remedy subjects Medicare 
contractors to administrative as well as trust fund damages. I am 
pleased that the Department of Justice and the HHS Office of Inspector 
General believe this special liability standard serves taxpayers and 
the Medicare program extremely well.
  In closing, let me again say how proud I am that on this issue and on 
the many other provider and beneficiary policies in this bill, Chairman 
Baucus and I were able to work together in a balanced, bipartisan 
fashion. Together, we carefully considered and came to agreement on 
payment, administration and benefit policies that make sense for 
Medicare. I urge the Senate Democrat leadership to call up our bill for 
full consideration in short order before we adjourn next week.

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