Federal law enforcement officials recently conducted a nationwide sting and arrested 90 people, including 16 doctors, in a Medicare fraud scheme that cost the taxpayer-funded program at least $260 million.
For decades, the Government Accountability Office has identified Medicare as being at high risk for improper payments and fraud. In 2012, Medicare reported that it had lost more than $44 billion in improper payments due to waste, fraud, abuse, and mismanagement. And that estimate may well be too low.
This is simply unacceptable. The loss of these funds not only compromises the financial integrity and increases the cost of the Medicare program, but also undermines our ability to provide needed health care services to the more than 54 million older and disabled Americans who depend on this vital program.
When I served as chairman of the Senate Permanent Subcommittee on Investigations, we held a series of hearings to examine fraud in the Medicare program. We identified the dangerous trend of an increasing number of bogus providers entering the system with the sole and explicit purpose of robbing it. One of our witnesses told us that he went into Medicare fraud because it was easier and safer than dealing drugs. He could make a lot more money at far less risk.
Our hearings led to the adoption of some safeguards and better internal controls, but unscrupulous individuals are always adapting their methods to rip off the system. The task of ferreting out wasteful and fraudulent spending is made all the more difficult by the ingenuity of these scam artists. One Florida physician actually told a patient that she had cancer-when she did not-just so he could bill Medicare for thousands of dollars in unneeded and painful treatments. That doctor is now in prison.
It’s important to note that the vast majority of medical professionals are caring, dedicated health care providers whose top priority is the welfare of their patients. They are the most appalled by the unscrupulous bandits who take advantage of weaknesses in Medicare to bleed billions of dollars from the program. That’s why it’s important that we continue to work to try and prevent this crime from occurring.
I currently serve as the ranking member of the Senate Special Committee on Aging, and along with Chairman Bill Nelson (D-Fla.), I have introduced a bipartisan bill called the “Stop Schemes and Crimes Against Medicare and Seniors,” or Stop SCAMS Act. Among other provisions, our legislation would require Medicare to verify health care provider ownership interests, using other databases, before they are allowed to enroll in the program. Currently, Medicare relies on self-reported information. As a consequence, providers who previously had an ownership interest in an organization that defrauded Medicare can potentially get back into the program by using different names and failing to disclose their interest in the previous organization.
Our legislation would also allow private insurers to share information about potentially fraudulent providers with Medicare and with each other to prevent further health care fraud. In addition, it would allow the Medicare Payment Advisory Commission to make recommendations regarding fraud prevention, and it would require the Medicare program to develop a strategy for reliably estimating just how many taxpayer and beneficiary dollars are lost each year to fraud.
It is unconscionable that there are fraudsters who are willing to scam the system and take advantage of some of our nation’s most vulnerable citizens. Our common-sense legislation would help make it more difficult for someone to commit the crime and save American taxpayers billions of dollars a year.
