Rep. Phil Roe Supports Bill That Enables Medicare Fraud

Rep. Phil Roe Supports Bill That Enables Medicare Fraud

Phil Roe Supports Bill That Enables Medicare Fraud

Phil Roe Supports Bill That Enables Medicare Fraud

Waste, fraud, and abuse in Medicare is rampant, quite regularly hospitals and healthcare providers routinely overcharge the largest federal healthcare program for services provided for patients. The Recovery Audit Contracts (RAC) program has proven to be extremely effective in identifying and rooting out Medicare fraud, but that doesn’t sit well with the hospital industry, that sees the aggressive rooting out of fraud as cutting into their profit margins. As special interest groups do, they turn bought-and-paid-for politicians in Washington D.C. to give them what they want. In this instance, the American Hospital Association, and other representatives of the major corporate hospital groups, want the RAC program gutted.

Politicians like Reps. Sam Graves (R-MO) and Phil Roe (R-TN), along with more than 100 others members of the House and the Senate, are there to dutifully serve the hospital interests, in gutting the RAC program, against the interest of their constituents back home in their districts. Rep. Graves has sponsored, and Rep. Roe and others co-sponsored, the “Medicare Audit Improvement Act,” which is H.R. 2156 in it’s 2015 form, and H.R. 1250 in its 2013 form. Simply put, this bill would gut the RAC program by severely limiting what percentage of billing could be reviewed by RACs, and placing other limits and restrictions on the program. In short, the bill would enable billions in Medicare fraud, and putting more money into hospitals over-charging Medicare for services provided.

By reviewing just a small fraction of Medicare billing, the RAC program had rooted out $8.9 billion in fraud in just one year, and could easily find an estimated $50 billion Medicare fraud if the program was expanded. Not only did Phil Roe not stand up for taxpayers, and his own constituents by advocating the full expansion of the RAC program, he has stood for shutting it down by sponsoring H.R. 1250 in 2013, the earlier version of the bill, sponsored by Rep. Graves, that would all but eliminate the RAC program.

The American Hospital Association (AHA) has spent $33.8 million in the last couple years in lobbying efforts on Capitol Hill against the RAC program. Additionally, the AHA and other groups representing hospital owning corporations have donated more than $4.1 million to politicians, in an effort to buy their votes for legislation like the Medicare fraud-enabling so-called Medicare Audit Improvement Act. The corrupt politicians receiving this money are the likes of Sam Graves and Phil Roe, who support the legislation to gut the RAC program that is so effective at countering Medicare fraud.

The identifying of who supports this legislation says as much about the cronyism and corruption involved as does those who oppose it. Grass-roots taxpayer advocacy groups like the National Taxpayer Union and Citizens Against Government Waste strongly oppose Rep. Graves’ bill because it’s very much in the interests of taxpayers to strengthen the Medicare program and save taxpayer dollars by rooting out waste, fraud, and abuse. Both organizations have urged Congress to defeat Rep. Graves’ bill. The RAC program could save taxpayers anywhere from $50 to $90 billion in Medicare fraud if fully implemented.

Cong. Phil Roe runs for office on the slogan, “people, not politics.” But his support for legislation gutting the RAC program is all about corrupt politics, and certainly not the interests of his constituents, the people that represents, whose primary interest in this issue saving taxpayer money on Medicare rather than lining the pockets of those who profit from owning huge hospital empires. Rep. Roe sides with his cronies in the healthcare industry that own hospitals, in direct conflicts with the interests of the people of his district. That isn’t doing his job in representing the people, that is serving cronyism and corruption.

It’s no coincidence, given how well Rep. Roe represents hospital interests, that the healthcare industry, by industries, ranks first among industries that donate large sums of money to his campaign fund. Between 2013-2014, they donated money than $85,000 to Phil Roe’s campaigns for reelection. Apparently it’s money well spent for needed favors, given that he over-rides the interests of the taxpayers in rooting out Medicare fraud by co-sponsoring the bill to gut the RAC program.

Politicians like Sam Graves and Phil Roe are best that special interest group money can buy. But the voters in their district should retire them and elect someone to represent them, and not the corrupt special interests, in Washington D.C. Voters need to change who they send to Congress, otherwise we can’t expect anything to change. Government in the nation’s Capitol is broken, and we can only fix it by ending the careers of the corrupt bought-and-paid-for politicians like Graves and Roe.

Medicare Fraud Enabling Bill Gaining Traction on Capitol Hill?

Medicare Fraud Enabling Bill Gaining Traction on Capitol Hill?

Rep. Sam Graves sponsors Medicare Fraud Enabling Bill

Rep. Sam Graves sponsors Medicare Fraud Enabling Bill

Legislation pending in Congress would gut effective anti-fraud efforts in the Medicare program, alleges the Council for Citizens Against Government Waste, EHR Intelligence reports. The legislation “would have a chilling effect on the RAC ( Recovery Audit Contractors) program, one of the government’s few successful initiatives to identify and recover waste, fraud, and abuse in Medicare,” EHR Intelligence stated.

Veteran observers of Congress know that vigilance is key. Just when appears the grassroots efforts might have nipped a terrible bill in the bud, it comes back with a vengeance.

Consumer advocates are drawing attention to a bill heavily pushed by the big hospital lobby that would enable Medicare fraud, resulting in billions of additional government dollars wasted on improper payments.

The bill, introduced by Rep. Sam Graves (R-MO), who is rated a fairly liberal Republican by the Madison Project analysis of his voting record, would gut an audit program that has identified billions of dollars in Medicare fraud at the beck of call of hospitals that would otherwise profit from that fraud.

The legislation, the “Medicare Audit Improvement Act,” (“improvement” here does not mean finding more fraud), already has 47 co-sponsors in the House.

The bill is co-sponsored by a number moderate to liberal Republicans as well as many Democrats, Real Clear Politics reports in listing the co-sponsors. Notably, not a single member of the GOP Doctors Caucus, a group of former doctors in the House who know healthcare well, has signed on.

The legislation targets the “Recovery Audit Contractors” (RAC) program, in which the government pays auditors a commission for successfully identifying fraudulent Medicare payments. Medicare annually issues roughly $50 billion a year in fraudulent payments, according to the Mercatus Institute, which is, for example, about twice the annual Gross Domestic Product of Paraguay.

Healthcare providers are fighting back against the RAC program and support the Graves bill, Forbes magazine reports.

(T)hey are fighting back in Congress. The Medicare Audit Improvement Act (S. 1012/H.R. 1250), which has bipartisan support in both houses of Congress, seeks to limit the powers of RAC auditors, even impose penalties upon them if they act improperly. These same auditing companies are none too happy about the bill, and claim it will cost the federal government billions if passed,” Forbes reported.

Consumer advocates remind us voters didn’t send them to Washington to enable Medicare fraud. Rep. Tim Huelskamp (R-KS), is an outspoken conservative who received a cool $1000 donation from the hospital lobby eight days after he signed on as a cosponsor. In fact, a close look at the list reveals numerous lawmakers who received donations very near to the time they cosponsored the bill – as well as many members who will face competitive elections and could really use the cash. Perhaps it’s not to cynical to see that the two are related.

Those payments go to hospitals who are essentially using improper payments to pad their profits, critics of the bill say, and don’t react kindly when meddlesome auditors inform the government those payments were actually illegal.

The hospitals, in turn, have vociferously complained that they are faced with overwhelming paperwork requirements in trying to keep up with auditors’ document requests. Maybe that is worth it if it effectively finds $50 billion in Medicare fraud.

There is something quite interesting about this issue. A top government official recently revealed at a congressional hearing that 51 percent of the hospitals’ appeals of the RAC audits were filed by five hospitals. So, only a small group of hospitals are asserting this is a problem, that they want to be fixed, regarding the RAC audit process.

Medicare fraud certainly is a real issues, as the Inquisitr reported last month, 243 individuals were charges with $712 million in false filings under Medicare. The Attorney General stated that this was the largest ever prosecution of health care fraud. Given the scope of the problem with Medicare fraud, it is understandable that if the RAC program is effective there will be significant opposition to legislation that might gut the program.

Is the Graves bill really a solution to a problem, or perhaps an elimination of a solution that some think is a problem? Consumer advocates and grass-roots activists will ultimately send a message to members of Congress, and it will remain to be seen if so-called Medicare Audit Improvement Act becomes laws or is defeated in Congress. Opponents of the bill clearly see it as an attempt to eliminated an effective anti-fraud program.

[Photo of Cong. Sam Graves from his official portrait via Wikipedia.]