Vice President Gore Announces New Efforts to Fight Health Care

      Message Creation Date was at 25-MAR-1999 13:11:00

THE WHITE HOUSE

Office of the Vice President

For Immediate Release       Contact:
Thursday, March 25, 1999      (202) 456-7035

VICE PRESIDENT GORE ANNOUNCES NEW EFFORTS
TO FIGHT HEALTH CARE FRAUD AND ABUSE

Also Launches New National Health Care Fraud and Abuse Task Force

Washington, DC -- Vice President Gore announced today new steps to fight


health care fraud and abuse, unveiling a legislative package that will
give the
Department of Justice (DOJ) new tools to address the billions of dollars
lost
to health care fraud each year.

 "While we should be proud of the billions we have saved in combating
health
care fraud, waste, and abuse since 1993, but we can and must do more," Vice
President Gore said. "These new efforts that will help ensure that programs
that are critical to our nation's elderly, poor, and disabled are not
siphoned
away by con artists and fly-by-night providers"

 Although improper payments have decreased by almost half since 1996 -- the
lowest error rate since the government initiated comprehensive audits three
years -- there is still more that needs to be done. Last year, the Federal
government paid $12.6 billion in improper payments from the Medicare Trust
Fund
and untold billions more on these type of payments in Medicaid, the Federal
Employee Health Benefits Program, and the CHAMPUS program, draining
resources
away from programs that provide vital care to the nationD!,s elderly,
poor, and
disabled.

 The Vice President announced that part of the AdministrationD!,s omnibus
crime
bill contains a comprehensive legislative package to fight health care
fraud
and abuse, providing the Department of Justice with new authority to:

 Prosecute and punish kickback offenses against Federal health care
programs. A         .
serious area of fraud is kickback schemes, where health care providers
unnecessarily send patients for tests or to facilities where the provider
is
financially rewarded. Today, Vice President Gore will announce a new
legislative proposal providing the Attorney General with the authority to
stop
criminal kickback schemes under Medicare, Medicaid, and state health care
programs while they are under investigation and create new civil money
penalties of at least $25,000 and up to $50,000 for individuals or entities
involved in these schemes. In addition, offenders would be responsible for
damages of triple the total compensation offered. Currently, Federal
prosecutors are unable to obtain injunctive relief for criminal kickback
offenses and are often forced to abandon in cases that, although they merit
government action, often do not rise to the level of criminal charges.

 Facilitating the prosecution of health care fraud. Today, the Vice
President
is announcing a new legislative proposal to eliminate the prohibition
against
the free exchange of information between.criminal investigators and civil
prosecutors in health care fraud cases and to allow government attorneys
to is
sue subpoenas in connection with any criminal or civil health care fraud
case.
Currently, the prosecution of health care fraud is often conducted in an
inefficient manner because criminal investigators and civil prosecutors are


prohibited from exchanging information .about cases that may be related. In
addition, the Department of Justice cannot independently issue subpoenas
when
investigating civil fraud cases, making it difficult to prosecute in a
timely
and efficient manner.

 Prevent providers from taking advantage of Medicare by declaring
bankruptcy.
Providers who have defrauded and abused Medicare often file for bankruptcy
in
order to avoid paying fines or returning overpayments, leaving Medicare
strapped with the bills. This provision would prevent individuals or
corporations who declare bankruptcy from discharging those debts associated
with their health care fraud conviction.

 Provide new fraud fighting authority to the Federal Employee Health
Benefits
Program. All Federal health programs except FEHBP are provided a number of
tools through the Health Insurance Portability and Accountability Act that
facilitate the investigation of health care fraud. However,  FEHBP, which
spends over $17 billion a year as the nationD!,s largest employer sponsored
health insurance program, does not have the same important tools. The Vice
President is announcing a new legislative proposal to expand the HIPAA
provisions to include FEHBP, providing: stronger sanctions for providers
who
have been convicted of health care fraud, including mandatory exclusion
from
FEHBP; expanded anti-kickback provisions to prevent FEHBP health care
providers
from receiving improper gratuities for referrals or related services; and a
lower standard of proof for fraudulent claims and increasing the penalty
per
false claim from $2,000 to $10,000.

 Ensure that penalties for health care fraud are adequate.  The Vice
President
will unveil a new legislative proposal to direct the United States
Sentencing
commission to study current sentencing guidelines for health care fraud,
and if
necessary, to amend them to reflect the serious harms associated with
health
care fraud by December 31, 2000. Currently, penalties for health care fraud
allow for significant leniency if the offending provider or corporation
admits
responsibility for the fraudulent act, making it possible for individuals
and
entities convicted of defrauding Federal health care programs out of
millions
of dollars to receive a sentence of probation with limited financial
culpabili ty.

 Mike Moore, president of the National Association of Attorneys General
(NAAG) ,
expressed the Association's support for the Administration's health care
fraud
initiative.

 "NAAG is pleased to join its law enforcement partners at the federal and


local
levels in sending a clear message to those who would defraud the health
care
system," said Mike Moore. "We are closing the gaps through you have
operated
and, as a result of this initiative, are creating a seamless web of
enforcement
to more effectively protect our vulnerable citizens from fraud and abuse."

 The Vice President also announced that the Department of Justice, the
Federal
Bureau of Investigation, the Department of Health and Human Services
Office of
the Inspector General, the National Association of Attorneys General, the
National District Attorneys Association, and the National Association of
Medicaid Fraud Control Units are forming an unprecedented task force to
develop
strategies to collaborate and investigate criminal and civil health care
fraud;
implement new training programs to teach prosecutors, investigators, and
other
law enforcement officials how to identify instances of health care fraud
and
the best way to build a health care fraud case. The Task Force will also
consider the full range of health care fraud and abuse issues, including
abuse
and neglect of individual patients in health care settings.

 The new steps the Vice President is taking today build on the
AdministrationO!,s longstanding commitment to crack down on health care
fraud,
waste, and abuse. Since 1993, the AdministrationO!,s efforts have saved
taxpayers more than $35 billion, and health care convictions have
increased by
more than 240 percent. Improper Medicare payments declined last year to the
lowest error rate since the government initiated comprehensive audits three
years ago.

 The Administration has assigned more Federal prosecutors and FBI agents to
fight heath care fraud than ever before, and in FY 1997 and 1998 -- thanks
to
the stable funding source created by HIPAA -- $1.2 billion was returned to
the
Medicare Trust Fund. In addition, the Department of Health and Human
Services,
together with the Department of Justice and the AARP, are working together
to
increase Medicare beneficiary fraud and abuse awareness. A recent outreach
campaign, titled O!&Who Pays? You PayO!8 encourages Medicare beneficiaries
to
review their Medicare statements and question improper charges.

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