The House Ways and Means Committee, Subcommittee on Health, recently held a hearing focusing on ways to combat waste, fraud and abuse in the Medicare system. The witnesses, from Congress and from federal agencies offered suggestions to address the issue and explained current measures already in place.

In his opening statement, Representative and Chair of the Subcommittee on Oversight John Lewis (D-GA) set the tone for the hearing: "Fraud and abuse of the Medicare system is a shame and a disgrace. It is an affront to the program and to seniors. Those who would abuse the system or engage in fraud strike at the very heart of the Medicare program...We cannot allow bad actors to weaken this important program."

The first panel featured the Congressional witnesses. Representative Peter Roskam (R-IL) advocated for his legislation, H.R. 5546. He explained that the bill would reform how Medicare pays claims by directing the Centers for Medicare and Medicaid Services (CMS) Office of Program Integrity to design a comprehensive pre-payment predictive modeling system. This system would be applied prior to reimbursing claims, and prevent improper payments from being made, Roskam said. "Predictive modeling can detect fraudulent claims that traditional rule-based edits cannot identify. CMS is currently developing an integrated data repository that will eventually contain all provider data that can be mined, but this will still be post-payment pursuit of fraud."

Representatives Ron Klein (D-FL) and Ileana Ros-Lehtinen (R-FL) are both sponsoring another bill, H.R. 5044, the Medicare Fraud Enforcement and Prevention Act of 2010. In the hearing, Klein said that the bill would address Medicare fraud by toughening current penalties, including doubling penalties for false statements and anti-kickback provisions in the Social Security Act. "These penalties have not been updated since 1977. In that time, criminal conspiracies have dramatically advanced their efforts to defraud Medicare."

The bill would also create a new offense for illegally distributing a Medicare or Medicaid beneficiary ID and establishes a maximum penalty of three years in prison and a fine up to the amount that was stolen from the government. Representative Ros-Lehtinen added that another part of the bill would create a pilot program implementing biometric technology to ensure that Medicare beneficiaries are physically present to receive services. "Many times, the elderly are conned into giving up their Medicare ID to unscrupulous service providers. These providers then bill Medicare for services that are never rendered and equipment that is never used," she explained.

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