Statements on Introduced Bills and Joint Resolutions

Floor Speech

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Mr. NELSON. Mr. President, I am joined today by my colleague Senator Collins to introduce legislation aimed at strengthening the government's hand in stopping Medicare fraud. Senator Collins and I have tried to offer some decent leadership to the Senate Special Committee on Aging and in the process we have heard a lot about Medicare and Medicaid fraud. I want to thank Senators CARPER, GRASSLEY, and CASEY for partnering with us to sponsor this legislation we are introducing today.

Earlier in the year Senator Collins and I convened a hearing of the aging committee to examine what government was doing to prevent Medicare fraud. The committee heard from law enforcement that despite the recent increase in prosecutions, Medicare fraud continues to run rampant. It is especially true in my State of Florida, where South Florida remains, unfortunately, ground zero for Medicare fraud.

We also heard from the Medicare organization itself about what the program is doing to try to better detect and prevent con artists from defrauding the system.

Then we heard from victims such as Patricia Gresko, a former schoolteacher from Michigan. She testified about this unbelievable scam where her doctor talked her into spending thousands of dollars for treatments for an illness she later discovered she didn't have. These treatments caused her to have chest pains and forced her to endure intravenous infusions that took hours.

Her doctor was arrested for bilking $225 million from Medicare. This is what he did: falsely telling patients they had cancer--if you can believe that, that they had cancer--so he could bill for expensive chemotherapy treatments. Ms. Gresko did not have cancer, but she had to endure all of that.

Today we are losing about $60 billion to $90 billion a year in Medicare fraud. Just last week, Federal agents arrested 90 people--50 of them, you guessed it, from Miami--on charges they had stolen $260 million from the Medicare Program. Fortunately, when we passed the Affordable Care Act, we put in provisions--some, I might say, at my insistence, because of ground zero being in my State--such as background checks, site visits for prospective Medicare providers and suppliers, and another one being stronger criminal and civil penalties, with the authority to withhold payment in law where there is a credible allegation of fraud. Those are just a few of the weapons in law as a result of the ACA.

This recent set of arrests of 90 people on charges of Medicare fraud tells us something else: We have to stop playing the game of Whac-A-Mole with Medicare criminals in trying to stamp out the fraud one bad actor at a time. You know what Whac-A-Mole is. You whack this creature on a table, and once you have whacked it, it pops right back up. So naturally, we talked to Sylvia Burwell, the President's nominee for Secretary of HHS.

She echoed that last week at her confirmation hearing in the Finance Committee. She stated that we need to move away from the pay-and-chase model--which is what has happened. You have to chase them down. If you catch them, they pop back up again. So we need a better strategy.

While we are making strides by more aggressively pursuing this kind of fraud, obviously more needs to be done. That is why today Senator Collins and I are introducing the Stop SCAMS Act. It will require Medicare to verify that those wishing to bill Medicare have not owned a company that previously defrauded the government. It is going to also allow private insurers and Medicare to share information about the potential fraudulent operators in the system.

The bill also anticipates problems CMS may face in the future. It doesn't delay the rollout of the 10 new medical codes in any way--or shall I say what they refer to as the ICD-10 medical codes; there are a lot more of those medical codes--but it takes some lessons learned from the costly delays that have occurred with these codes and uses them to make the process better in the future. The legislation also requires, for the new medical coding systems after the ICD-10, that the agency assess the impact on fraud-prevention systems and do appropriate testing.

Combating this fraud will continue to be one of the core missions of our Committee on Aging. We have taken a look at many types of fraud scams--Jamaican phone scams, identity theft, Social Security fraud, payday lending--and now we are continuing to focus on Medicare fraud and will continue to examine additional issues.

Every day, Senator Collins and I hear from seniors about scams, and they let us know on our committee's hotline. I remind everybody: This hotline is there for you to report these scams--1-855-303-9470--and we are going to keep this committee going after these scams.

In the meantime, Senator Collins and I hope our colleagues will join us in support of this legislation to try to further clamp down on Medicare fraud. I am so happy to have the partner I have in helping lead the Committee on Aging, Senator Collins.

In closing, I would say that we really have a broad array of folks supporting us on this legislation: the National Health Care Anti-Fraud Association, America's Health Insurance Plans, Blue Cross and Blue Shield Association, the National Coalition Against Insurance Fraud, the National Insurance Crime Bureau, and Humana Insurance Company. They are all supporters of this legislation.

Mr. President, I await the comments of my colleague.

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