Every dollar lost to Medicare fraud is a dollar stolen from America’s elderly. And every dollar lost to improper payments – intentional or not – robs from the solvency of this important program.
Today’s hearing will examine the issue of Medicare fraud. This is a bipartisan concern shared by our seniors, the Medicare program and lawmakers on this committee.
The Office of Inspector General, which is testifying here today, cites that nearly $50 billion is lost to improper Medicare payments each year. That is an alarming amount.
I am also alarmed by how often I open the Houston Chronicle back home to find stunning investigations of Medicare fraud that runs into the tens of millions of dollars involving doctors, ambulance companies, mental health clinics and even patient advocates – those who are tasked with protecting the sick and elderly.
Last Friday brought news of a 13-count indictment of providers in Florida and the Houston area for allegedly billing Medicare for services that were not needed and providing kickbacks for patient referrals.
And last Wednesday it was the sentencing of a Houston area woman after her 2013 conviction for defrauding Medicare. These stories are all too frequent in communities around the nation.
To make matters worse, in the past year, the Office of Inspector General has documented evidence that that Medicare has paid for services to those who are deceased, in prison, and not entitled for benefits. All this while Medicare’s main trust fund is on a crash course with insolvency in a short twelve years.
President George W. Bush established the federal Medicare Fraud Strike Force in 2007 that changed to a much more aggressive approach to Medicare fraud, and it is starting to bear fruit. In response the Centers for Medicare and Medicaid has taken strides to address this growing problem.
The agency has used its authority to impose a temporary moratorium on the enrollment of certain providers in high-risk areas, including preventing new ambulance companies from billing Medicare in Texas. However, more must be done to protect our seniors and taxpayers.
While a moratorium on new providers may very well prevent unscrupulous providers from entering the program, it does not stop those who are already enrolled and improperly billing. More must be done to move from the outdated “pay and chase” approach to at 21st Century approach which stops improper payments before they go out the door.
I am also concerned about CMS’s lack of leadership and interest in problems that are especially embarrassing for the Medicare program. Preventing payments for services to those who are dead or are in jail involves a straightforward fix yet it is still a problem, regrettably still a topic for discussion at this hearing.
And that is the focus on this hearing: not merely identifying the fraud and abuses but identifying what can be done now using technologies and successful strategies to prevent and deter fraud in the future.
First, I commend my colleagues on this Committee—Members on both sides of the aisle—who have introduced bills that make commonsense changes.
For example, my colleagues and fellow Texans, Mr. Johnson and Mr. Doggett, have been working on a legislative fix for nearly a decade to take Social Security numbers off of Medicare cards.
It is frustrating that such a simple fix has yet to happen. I look forward to the day when I can tell the seniors in my district that they no longer must worry about having their Social Security number compromised simply by carrying the Medicare card they need to access their health care.
Secondly, we are interested in hearing recommendations from the OIG and Government Accountability Office. These watchdog entities have identified vulnerabilities and proposed solutions in the areas of improper payments and CMS oversight of claims paying and fraud fighting contractors. Many of these recommended fixes support bills that members of Congress on this committee are championing.
Thirdly, we will hear from CMS about its Program Integrity efforts. While we are interested to hear what the agency has done, we’re perhaps more interested in what it plans to do going forward.
The written statements from our witnesses make clear that much work is left to be done. Lawmakers have ideas, OIG and GAO have made recommendations, and CMS has its plans. So let’s identify the ideas that solve our problems and get to work putting them in place. Now.
It’s not important who came up with the idea. What is important is that we act on these good ideas. It is my intent that we move forward on a bipartisan basis, working with CMS, to protect our seniors, bolster the Medicare Trust Fund, and ensure appropriate use of taxpayer funds.