[Congressional Record (Bound Edition), Volume 156 (2010), Part 3]
[Senate]
[Pages 2940-2941]
[From the U.S. Government Publishing Office, www.gpo.gov]




                             MEDICARE FRAUD

  Mr. LeMIEUX. Madam President, yesterday, the President was in St. 
Charles, MO. He talked about a new effort the Federal Government would 
undertake to go after waste, fraud, and abuse in the health care 
system. He focused on the use of payment recapture audits and the teams 
of auditors who will now go through the process of looking at the 
payments being made in Medicare, for example, health care for seniors, 
to make sure the money is actually going for health care to seniors and 
not going to criminals who are stealing money from the system. I 
commend the President for doing this. It is the right thing to do. 
Republicans and Democrats can work together. This is a good initiative.
  But I would like to request of the President, as I have requested of 
this Congress, to take further steps and more bold steps to stop fraud 
in the system.
  I thank Leader McConnell who, in his opening remarks this morning as 
the Senate opened its session, commented on a piece of legislation I 
have offered that will not only go after the fraud after it happens, 
which is what the President's proposal does--and I commend him for it; 
it is estimated by folks looking at his proposal that it might save $2 
billion a year by going through and auditing and trying to find out 
where the bad guys have taken the money. I have some experience in 
that. When I was deputy attorney general in Florida, working under 
then-attorney general Charlie Crist, we had a Medicaid fraud control 
unit.
  On the Medicaid side--health care for the poor--we did just what 
these teams the President is putting together now are going to try to 
do for Medicare. We had teams that looked at the data. We would break 
down the list of the top 50 folks who were receiving reimbursements 
from the Federal Government, and if the number and the amount of money 
they were receiving was abnormally high, we would look at it and make 
sure it was legitimate. You could go where money is. Right? They say: 
Look where the money is going. And if you can find out where the money 
is going, you can find out what the problems are.
  We looked at the top 50 or top 100 folks who were receiving 
reimbursements from Medicaid, and we found problems. So the President's 
idea is effective. But let's not just do pay and chase. That is what we 
have been doing in health care for years and years and years.
  The Presiding Officer, the Senator from North Carolina, agrees with 
me on this issue. She has been a leader in advocating that we stop the 
health care fraud before it starts. We were trying to change the health 
care bill last year at the end of the year to put in something more 
robust.
  We do not have to start from scratch. There is an idea out there that 
already exists that is already working in another sector of the economy 
that is very similar to what could be done in health care.
  Health care is about a $2 trillion a year business. We know that in 
Medicare, there is at least $60 billion if not $100 billion a year of 
health care fraud. That is worth repeating: $60 billion to $100 billion 
a year of waste, fraud, and abuse in Medicare alone.
  My colleague, Senator and Dr. Coburn, has been a leading advocate 
about trying to go after this waste, fraud, and abuse.
  So what could we do with that money? We could put that money back 
into Medicare to make sure we are actually helping patients and make 
Medicare solvent for years to come, instead of where we are looking at 
it right now: that in the next 7 years Medicare is going to have a real 
financial crisis.
  So how do we get at that $60 billion to $100 billion a year of waste, 
fraud, and abuse? Well, the health care industry is about a $2 trillion 
industry. Another industry that does a fantastic job of fighting fraud 
that is also an industry of about $2 trillion is the credit card 
industry.
  In health care--at least in government health care--we believe $1 out 
of every $7 is fraud. In the credit card industry, they lose 7 cents on 
every $100. Madam President, $1 out of every $7 versus 7 cents on every 
$100.
  How do they do it? They do not do just pay and chase; they do not 
just set up auditors and prosecutors to go after the bad guys after 
they have stolen the money. They stop the stealing before it starts. 
Technology is a wonderful thing, and it has created tremendous 
abilities for us to prevent fraud before it begins.
  You all have had this experience. You have gone somewhere and used 
your credit card, and your credit card company has e-mailed you or 
called you and said: Was that really you making that purchase? And why 
is that? Well, a mechanism was triggered by their computers, where you 
were doing something you normally do not do. You were outside your 
normal spending habits. You were in Washington, DC, visiting, not at 
home in Orlando, FL. That is not something you usually do. A red flag 
goes off because they built a computer model that tracks your normal 
purchasing, and if something is out of normal--if you are traveling or 
you are purchasing more than you usually do, or you are buying things 
that are the target of people who steal credit cards--the model goes 
off, the phone call happens, and if you do not verify, they do not pay.
  This is called predictive modeling, and it makes all the sense in the 
world that we put this into our health care system. And we can. I have 
a bill, S. 2128. It has bipartisan support in the Senate with about a 
dozen cosponsors.
  It is a bill to do three things. One, create the predictive modeling 
system,

[[Page 2941]]

set up a computer program where if we have health care fraud, we can 
try to detect it before it starts.
  Let me give you an example. My home State of Florida is rampant with 
health care fraud--rampant. In fact, I think south Florida is the 
capital, unfortunately, of health care fraud. Here is one example to 
give you: We have in south Florida 8 percent of the Medicare 
beneficiaries with HIV or AIDS nationwide, but 72 percent of the 
reimbursements to these patients are sent there.
  Is that because they are getting the best health care in the world? 
No. It is fraud. There are people in organized crime who are running 
these health care codes, stealing medical records from hospitals, 
finding out your patient information, saying that you have AIDS, 
running a $2,400 vaccine, and running those vaccines all day long, 
sending the bill to the Federal Government. The Federal Government is 
paying. It is a lot better deal for the crooks. It is a lot better than 
illicit drugs. We hear from these criminals they would much rather be 
stealing from the Federal Government. No one is shooting at them, and 
it is a lot easier to rip off Uncle Sam.
  We have to stop this. So if you put this predictive modeling system 
in place, you could actually have a trend that occurred, and the 
computer would say: Wait a minute, this ``health care provider'' has 
sold this wheelchair 100 times in an hour, or they sold this other 
medicine, this very expensive AIDS medication. They have prescribed 
that more than anybody else. The model goes off and the payment stops 
until they are verified. We stop the fraud before it starts.
  My bill does two other things. One is, it requires a background check 
for every health care provider in America that is going to try to bill 
Medicare or Medicaid. Can you imagine that we do not do that right now? 
We do not do background checks of people who are allegedly providing 
health care to our seniors and to the poor. Can you imagine, we have a 
convicted murderer in Florida who was an alleged health care provider 
who was scamming the system? There are bad guys scamming the system for 
$10 million, $20 million, $50 million, $60 million. So we have to do a 
better job.
  The third thing this bill does is it creates some accountability. We 
are going to create an Assistant Secretary of Health at the Department 
of Health and Human Services whose only function will be to fight fraud 
so we have some person accountable who we can call in front of our 
committees and say: How are you doing in the battle to fight fraud?
  As much as I appreciate what the President did today--and that could 
save $2 billion--a group here in town has evaluated this bill that has 
bipartisan support and they say it could save $20 billion a year. So 
why aren't we doing this today? I know this health care bill is very 
important. We have differing views on whether we should pass the big 
bill. But why can't we pass my bill now? Why can't we start preventing 
this health care fraud now and save $20 billion a year?
  Imagine what we could do with that money. Imagine what we could do to 
put that money back in Medicare and make it more resilient so our 
seniors know their health care is going to be paid for.
  I applaud the efforts of the President of the United States today. It 
is a good step. But it is on the pay-and-chase side. It is not on the 
prevention of fraud side. I keep coming to the floor and talking about 
this because I feel so passionately about it. It is a commonsense thing 
to do. It is problem solving. It is not partisan. No one is for fraud. 
Everybody should believe that we should try to spend the government's 
money more effectively and more efficiently.
  With that, Madam President, I yield the floor.
  The PRESIDING OFFICER. The Senator from Delaware.
  Mr. KAUFMAN. Madam President, I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The assistant legislative clerk proceeded to call the roll.
  Mr. KAUFMAN. Madam President, 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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