Anti-Fraud Initiatives in Afforadable Care Act Provide Effective New Tools for CMS

Statement

Today, Dean of the U.S. House of Representatives, John D. Dingell (D-MI15) issued the following statement at the House Energy and Commerce Subcommittee on Oversight and Investigations hearing titled, "Waste, Fraud, and Abuse: A Continuing Threat to Medicare and Medicaid.":

"This Committee has a long, proud history of oversight and investigations into waste, fraud and abuse in all sectors of our government. Some of these investigations have turned up improper contracts or wasteful government purchases, others local con artists trying to rob the neediest populations of their assistance. Regardless, all have proven that we must continue to dedicate the personnel and financial resources necessary to crack down on waste, fraud and abuse, while also preventing and detecting these practices before they happen.

"The Affordable Care Act included a number of anti-fraud provisions that are helping CMS today to increase their efforts to crack down on fraud and also provide the appropriate tools to prevent fraud before it occurs. Some of these provisions include:

* New enrollment requirements that will help CMS to identify and eliminate fraudulent providers prior to any payment from Medicare and Medicaid,
* Stronger penalties for fraudulent providers,
* Requirements for providers to establish plans on how they will prevent fraud,
* Increased funding for fighting Medicare and Medicaid fraud, and
* Enhanced data sharing that allows CMS, DOJ, states and other federal health care programs to share information.

"The Obama Administration has acted swiftly to implement these provisions, issuing final rules on home health and hospice referrals in November 2010 and in provider and supplier screening requirements, enrollment moratoria and payment suspension in January 2011.

"The use of these new tools will help CMS to continue to fight back against criminals who are raiding two of our most important health care programs. This is critical to protecting the services American seniors and families rely on, but also to reducing the deficit. Since 1997 the Health Care Fraud and Abuse Control Program has recovered and returned $18 billion to the treasury. According to HHS and DOJ, for every dollar spend on Medicare and Medicaid fraud enforcement spent since that time, $4.90 has been recovered and returned to taxpayers.

"I was fortunate enough to join the Detroit Strike Force Team this past summer for a ride-along to witness firsthand the good work the strike force teams are doing to identify and stop fraud in so-called health care fraud hotspots. Because of the strike force's efforts in Detroit, more than 40 people have been convicted, 90 others have been indicted and courts have ordered criminals to repay over $23 million to Medicare. As the first Member of Congress to ever join any unit of the Medicare Fraud Strike Force for a ride-along, this visit reinforced the need to protect the poor, the elderly and the sick from crooked criminals who have no shame in stealing Medicare from those in need.

"I look forward to hearing from our witnesses today and hope to learn more about what Congress can do to crack down on waste, fraud and abuse before it occurs."

Congressman Dingell has for years been a leading watchdog for fraud and abuse and a passionate protector of Medicare and Medicaid. He continues vigorous oversight in the 112th Congress to see that the implementation of and funding for the Affordable Care Act law, of which he is the author, are done in a fully fair manner that benefits all Americans.

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