"The Human And Financial Toll Of Medicare Fraud"

Imagine being told by a doctor that you have a medical condition that requires invasive, painful, and expensive treatments-with the majority of the cost billed to the Medicare program-- only to later learn that these treatments were not medically necessary after all. This is exactly what happened to a retired woman from Michigan who recently testified before the Senate Aging Committee, on which I serve as the Ranking Member.

This woman saw a doctor for the first time several years ago. She described him as reputable and as someone who she thought could be trusted.  These are attributes that patients expect of their doctors.  The doctor told her that she had a problem with her immune system and would require monthly IV medications. These infusions, which caused painful side effects, took seven hours to administer, and were given to her over the course of many months. One can only imagine her angst when she learned that the very doctor she had trusted to diagnose and treat her had been arrested and taken into custody for Medicare fraud.  In addition to more than $1,500 in co-pays that she paid, this unscrupulous doctor had received $14,000 from the Medicare program for administering these unnecessary treatments.

This story is truly troubling and unfortunate, but sadly, one of far too many examples of the Medicare fraud that takes both human and financial tolls on our nation.

To be clear, the vast majority of medical professionals are caring, dedicated providers whose top priority is the welfare of their patients.  They, too, are appalled at the unscrupulous bandits who take advantage of weaknesses in Medicare to bleed billions of dollars from the program.  But instances of fraud remain, and therefore are the reason why the Aging Committee recently held a hearing to examine ways to prevent Medicare fraud.

For more than two decades, the Government Accountability Office (GAO) 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 unfortunately, that estimate may well be too low. 

This is simply unacceptable.  The loss of these funds not only compromises the financial integrity of the Medicare program, but it 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.

In far too many cases, Medicare fraud schemes have directly affected the quality of care and put some of our most vulnerable patients at risk.  Many patients are harmed as a result of unnecessary procedures or medical services provided as part of schemes to defraud Medicare. 

When I served as Chairman of the Permanent Subcommittee on Investigations, I held a series of hearings to examine fraud in the Medicare program.  My subcommittee 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 than dealing drugs.  He could make a lot more money at far less risk.

In other cases we investigated, more than $6 million in Medicare funds were sent to durable medical equipment companies that provided no goods or services whatsoever.  One of these companies even listed an absurd fictitious address that, had it existed, would have been in the middle of the runway of the Miami International Airport.

While we have made progress in the battle against Medicare fraud since I chaired those hearings several years ago, the con artists have become increasingly clever in their schemes to rip off Medicare.  We are devoting increased funding to Medicare program integrity activities to prevent improper payments and to detect fraud and prosecute offenders.  Since it is estimated that we recover more than $8 for every dollar spent on anti-fraud activities, these are wise investments of federal funds.

In addition, Medicare contractors are now conducting on-site visits of durable medical equipment suppliers and other providers to make sure that they are legitimate businesses and meet required standards before they enroll in Medicare.  And, we are doing a better job of screening Medicare providers by using licensing and background checks to stop fraudsters from entering the program in the first place. But we must continue to fight Medicare fraud aggressively and work harder to prevent fraud schemes from happening in the first place.

During the recent Aging Committee hearing, we heard from government witnesses who described these efforts on the federal level.  Seniors in Maine and throughout the nation can also play an important role in working to identify and combat Medicare fraud.  It has been said that consumers are on the front-line defense.

The Maine Senior Medicare Patrol (SMP) has outlined some important steps that seniors can take to help ensure that they do not become victims of Medicare fraud. SMP advises:

• Treat your Medicare number like a credit card. Never give it out over the phone unless you initiated the call. If your card is lost or stolen, report it immediately to 1-800-MEDICARE.
• Do not accept free medical services or equipment in exchange for your Medicare number. Unscrupulous companies or individuals could use this number to bill Medicare for services or products you did not receive.
• Review your Medicare statements closely and keep a watch out for services that you did not receive.
• If you suspect fraud, report it immediately.  The Office of the Inspector General for the U.S. Department of Health and Human Services maintains a fraud hotline: 1-800-HHS-TIPS. The Senate Aging Committee also has a fraud hotline: 1-855-303-9470.

Medicare is vital to more than 54 million older and disabled Americans. No patient's health should ever be put at risk because of dishonest individuals who take advantage of this program that is so critical to our nation.