Medicare Fraud

Floor Speech

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, 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.

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