Expect Congress to raise the heat on Medicare fraud

Proposals already surfacing

The arrival of an election year is being felt throughout Washington, DC, and the Medicare arena is no exception. As a result, insiders expect Congress will make Medicare fraud a campaign issue. The likely outcomes: closer scrutiny of claims and pressure on agency investigators to come up with trophy cases for prosecution, coupled with a move by Congress to make patients part of the fraud police.

The Democrats have already started reframing this year’s legislative agenda and congressional campaign themes by putting Medicare waste and fraud on their short list of issues.

Leading Democrats, like Sen. Harry Reid (D-NV), chairman of the Senate Democratic Policy Committee, have come out saying cutting waste and fraud could save Medicare from pending bankruptcy.

A solution to Medicare's financial woes

"Before we reduce benefits, raise taxes, or change eligibility standards, let us first ensure current and future beneficiaries that fraud, waste and abuse are being addressed," Reid told a hearing on Medicare reform last December. The December hearing was the first in a series Reid plans to hold to help shape the Democratic agenda and set the tone for the 1998 mid-term elections.

The Balanced Budget Act (BBA) of 1997 produced an estimated $115 billion worth of savings designed to keep Medicare from bankruptcy until the year 2007. In the meantime, a bipartisan commission is to search for long-term solutions to Medicare’s financial troubles.

Referring to the recent report from the Department of Health & Human Services showing nearly $23 billion a year in Medicare payments that range from being questionable to outright fraudulent, U.S. Rep. John Ensign (R-NV) has accused Democrats of avoiding tough choices when it came to Medicare while they controlled Congress.

Besides increased funding for federal fraud investigators and increased claim audits, one proposal gaining popularity among both parties is to train the elderly to help spot and report potentially illegal activity among providers.

"Since these are the people who use and benefit most from the system — and have plenty of time on their hands — it seems a natural to include them in our fraud prevention arsenal," notes one House staffer.