The hearing began with testimony from several representatives working on this issue. Congressmen Peter Roskam (R-Ill.), Ron Klein (D-Fla.), and Scott Murphy (D-N.Y.), along with Congresswoman Ileana Ros-Lehtinen (R-Fla.) were in agreement about the severity of the problem – several cited Medicare waste estimates in the tens of billions of dollars.
Congressman Roskam emphasized the need to eliminate what he called the “pay and chase” model – the idea that medical claims are often times already paid before fraud is noticed. Roskam told the subcommittees it would be more efficient to catch fraudulent charges before they are paid out.
Among the proposals discussed to fix the problems with the Medicare system were strengthening prescreening requirements to enroll as a Medicare vendor, increasing criminal penalties for fraud, performing random audits of claims, and committing increased resources to information-sharing.
Several congressmen also emphasized the importance of taking advantage of technological progress. Congresswoman Ros-Lehtinen says biometric technology would provide assurance that the patient Medicare is billed for actually received some form of treatment.
“Many times the elderly are conned into giving away their Medicare IDs to unscrupulous providers that bill Medicare for services that are never rendered and equipment that is never used,” Ros-Lehtinen said.
The possibility of using the type of predictive safeguard programs already used by credit card companies to detect fraud was also raised by Ways and Means committee member Congresswoman Ginny Brown-Waite (R-Fla.).
Health Subcommittee chairman Pete Stark (D-Calif.) said he hoped the hearing would help spur action on the topic.
“Whatever we can do legislatively, I’d like to proceed that way,” Stark said. “Let’s accept where we are and see if we can move forward with programs that will reduce fraud, waste and abuse.”
Lewis Morris, Chief Counsel for the Office of the Inspector General at Health and Human Services (HHS); Edward Siskel, Associate Deputy Attorney General; Kathleen King, Director of Health Care at the Government Accountability Office (GAO); and Kimberly Brandt, director of Medicare Program Integrity at the Centers for Medicare and Medicaid Services also testified.
The impact of the Democrats’ new health care law on their efforts was a major topic of discussion. Each said they believed the law will help to reign in Medicare fraud.
Siskel said he expected the law to increase prosecutions with stricter penalties, prevent potential fraudsters from entering the Medicare system, and facilitate the recovery of defrauded money.