S. 3900: Sen. Coburn’s Medicare Fraud Buster: Part II

The Heartland Institute has More, on;

Coburn Introduces Legislation To Stop Medicare And Medicaid Fraud

“….. According to Devon Herrick, a health policy expert with the National Center for Policy Analysis in Dallas, Texas, the success of Coburn’s proposal will depend on whether other members are willing to stand up on the issue.

“Senator Coburn has some great ideas, but Congress has to develop the political will to follow through with them,” Herrick said. “In the past, one of the biggest impediments to fighting waste, fraud and abuse in Medicare and Medicaid is when politicians intervene on the behalf of constituents, who are abusive service providers and equipment suppliers.”

Obamacare was So desperately needed that we had to pass the Bill so that we could find out what was in it. And despite that Desperation to save us all from a fate worse than death:

CRS Report: HHS Misses One Third Of Administrative Deadlines - by Ben Domenech

More (pdfs) on Sen. Coburn’s proposed Fraud Buster foot the main article/top link. Please read them all. Then call your own Congress Folk and tell them to support S. 3900. We can no longer afford $100 Billion a year of Rip Off as some sort of wink and a nod fringe benefit.

Here’s the pdf on Sen. Coburn’s Questions and Answers.

The “FAST” Act of 2010

Questions & Answers

Q. Why are you introducing this bill now, when you opposed the health care law?

A. While we opposed the new law when it was considered in Congress, we believe we have a duty as public servants to do all we can to protect Americans’ tax dollars. Program dollars should pay providers for caring for patients, not line the pockets of criminals who commit fraud. Waste, fraud, and abuse not only threaten the financial viability of programs, they erode the public trust. No group of stakeholders in America would be expected to tolerate high rates of waste, fraud, and abuse in any private company, and we should not expect American taxpayers to tolerate rampant waste, fraud, and abuse in publicly-funded health care programs.

The new federal health reform law will spend $2.6 trillion more taxpayer dollars over just a 10-year period, and we are gravely concerned that the loss and abuse of taxpayer dollars due to waste and fraud could increase under the new health law. We believe this concern is well placed, as our largest federal health care programs, Medicare and Medicaid, are already rife with waste, fraud, and abuse.

Q. All programs have flaws and all big systems have inefficiencies. Don’t politicians exaggerate the seriousness or scope of waste, fraud, and abuse in Medicare and Medicaid for politician gain?

A. No, the waste, fraud, and abuse in Medicare and Medicaid is real, widely-known, and very serious. Many independent, nonpartisan experts – from HHS’ Inspector General, to the Government Accountability Office, to the Department of Justice, and various media outlets – acknowledge the pervasive and persistent nature of waste, fraud, and abuse in these programs.

Q. How do these reforms impact providers?

A. We believe this bill encapsulates a host of common-sense, bipartisan reforms that would strengthen program integrity while minimizing the impact on physicians and other health care providers. One important element of reducing waste, fraud, and abuse is equipping CMS with the necessary authorizations and abilities to stop payments from going to pay crooks, not care providers. Unfortunately, too often, CMS’s current business practices send taxpayer dollars out the door without sense of whether or not a provider is paid and a patient is cared for.

A story from The Miami Herald reported the account of Ihosvany Marquez. Marquez recently plead guilty “to federal health care fraud charges alleging he made $55 million in false Medicare claims between 2005 and 2007.” He spent “his Medicare millions on a fleet of luxury cars, authorities say, including a Lamborghini….” This serious abuse of taxpayer dollars is unacceptable, but it is not highly unusual. Changes are necessary to increase the integrity of the program and ensure Medicare and Medicaid dollars pay for patient care.

Q. If this bill were to become law, would this bill eliminate fraud in Medicare and Medicaid?

A. There are many things that Congress and the Administration can to do eliminate waste, fraud, and abuse in Medicare and Medicaid. We believe this bill is a step in the right direction. The new federal health reform law dramatically expands Medicaid, significantly changes Medicare, creates substantial new mandates and regulations, and will send hundreds of billions of dollars to insurance companies. We are concerned that this dramatic expansion of government spending will create significant vulnerabilities to waste, fraud, and abuse.

Furthermore, we are concerned that the fraud and waste provisions in the new law fail to address these vulnerabilities. In fact, the independent nonpartisan Congressional Budget Office estimated that over the next decade under the new law, only $6.7 billion dollars will be saved from fraud in Medicaid and Medicare. We are very concerned that, under the new reform law, taxpayers and patients will continue to lose out to criminals who commit fraud.

The HHS’ Inspector General’s Office for the Department of Health and Human Services said in Congressional testimony that “curbing fraud, waste, and abuse must be an essential component of any health care reform strategy.” They said “for the U.S. health care system…to remain solvent for future generations, we must pursue an effective strategy to combat fraud, waste, and abuse.” The IG’s office identified five principles as core policy recommendations, but there are many more good ideas about ways to stop fraud. Here are a few by the IG:

· Highlights of Address by HHS OIG at the Health Care Compliance Association Annual Compliance Institute

· Aging Committee testimony, 2009

· House E&C testimony, 2009

· House Approps Committee testimony, 2010

· Unimplemented recommendations, 2008

· U.S. Senate Homeland Security and Governmental Affairs Subcommittee on Federal Financial Management Testimony, 2009

Many experts have also authored books and research papers on this topic – some descriptive of the problem, others prescriptive with solutions. Harvard University’s Malcolm Sparrow is a respected author and anti-fraud expert who wrote the seminal License to Steal: How Fraud Bleeds America’s Health Care System. He testified to Congress that official estimates are “lacking in rigor,” are “comfortingly low and quite misleading,” even excluding many kinds of fraud and abuse. Sparrow thinks that as much as 20 percent of the federal health care budget is consumed by fraud, which would be about $90 billion a year for Medicare alone. One recent book edited by fraud expert Jim Frogue, Stop Paying the Crooks, catalogues a wide variety of anti-fraud recommendations from a host of experts that can be used to prevent taxpayer dollars from funding criminals.

When taxpayers are losing $60-100 billion dollars a year to waste, fraud, and abuse in Medicare and Medicaid, Congress and the Administration must do more to save taxpayers’ dollars. We look forward to working with anyone interested in providing solutions to reduce waste, fraud, and abuse.