Tom Harkin

Mr. HARKIN

Mr. HARKIN. I listened to the Senator make the explanation but I thought the amendment was going to go toward limiting attorney's fees if there is a global settlement, this thing we are being asked to do at some point. We do not know if it is this fall, next year, or whatever, when we will be asked to ratify a so-called global settlement. But your amendment does not just speak to that, it speaks to ongoing cases in the States. For example, as I understand it, the State of Mississippi just settled, the State of Florida just settled, other States will maybe be settling. Your amendment seems to me to apply to those States that make those settlements. It has nothing to do with the proposed universal or global settlement that we will be asked to ratify at some point later on. That is why I wonder, by what right or power do we have in the Federal Government of saying to a State government, a State attorney general and the State government that you can't, in your agreement, whatever your agreement is, you have to limit attorney's fees? That seems to me to be an odd kind of a thing for us to do--the Federal Government telling the State government when you make your agreement, here is all you can do. It does not seem to me to be constitutional.

Mr. HARKIN. Again, I understand and I appreciate the Senator pointing that out. Mississippi made an agreement, Florida has made an agreement, maybe there will be a couple of other States that make agreements, what if later on we make a global settlement, do they have to go back and renegotiate all the attorney's fees? That is what I wonder. How can we tell a State what they have to do prior to our reaching this national settlement--and whether we reach it or not, I do not know. What would happen, for example, to a State like Mississippi that has already negotiated and make their deals--I guess, I assume they have.

Mr. HARKIN. The Senator was not aware of that. I appreciate that. I yield the floor.

Mr. HARKIN

Mr. HARKIN. I would want to have 10 minutes in the event somebody over here wants to speak. So I would like it to be 10 minutes for Senator McCain and 10 minutes on this side.

Mr. HARKIN. Reserving the right to object, Mr. President. As I understand it, the unanimous consent would be that after the hour of debate, equally divided, under the McCain amendment, since points of order are not debatable, it would be a motion to waive. If there is a motion to waive the point of order, that would be debatable, and Senator McCain wants 10 minutes under that process.

Mr. HARKIN. Mr. President, just one moment.

Mr. HARKIN

Mr. HARKIN. Mr. President, I have an amendment for myself and Mr. Bingaman and Mr. Kennedy regarding school testing. This has not been agreed to either.

Mr. HARKIN. Mr. President, I ask the amendment be temporarily set aside.

Mr. HARKIN. Mr. President, I ask to vitiate the yeas and nays.

Mr. HARKIN. Mr. President, I ask unanimous consent that reading of the amendment be dispensed with.

Mr. HARKIN. Mr. President, I request we call up the Reid amendment, No. 1094.

Mr. HARKIN. Again, I also ask it be temporarily set aside.

Mr. HARKIN. Mr. President, I ask unanimous consent that reading of the amendment be dispensed with.

Mr. HARKIN. Mr. President, I have another amendment I send to the desk on behalf of Senator Daschle and Senator Kennedy.

Mr. HARKIN. Again, in accordance with the procedure, I ask the amendment be temporarily set aside.

Mr. HARKIN. Mr. President, I ask unanimous consent that reading of the amendment be dispensed with.

Mr. HARKIN. Mr. President, I further ask, in accordance with the procedures set forth by the chairman, they be set aside.

Mr. HARKIN. Mr. President, I ask unanimous consent that reading of the amendments be dispensed with.

Mr. HARKIN. Mr. President, for many years, I have worked to identify and eliminate fraud, waste, and abuse in the Medicare Program. Senator Specter and I have held hearing after hearing and released report after report through our subcommittee. And along the way, we have had some successes. We've stopped a number of scams and ripoffs and we've forced Medicare to reduce excessive prices for a number of devices. These actions have saved Medicare and taxpayers over $1 billion. However, the problem continues to grow. Much more needs to be done. Several years ago, the General Accounting Office testified before our Appropriations Subcommittee that, based on their analysis, Medicare was losing up to 10 percent of its expenditures, or $16 billion to fraud, waste, and abuse. However, on July 17, HHS Inspector General June Gibbs Brown released a major new report that indicated that the problem was even worse. It was the first national audit of a statistically significant sample of Medicare claims for payment errors. This chief financial officer [CFO] audit found that up to 14 percent of Medicare payments in 1996 were made inappropriately. That's up to $24 billion in 1 year alone. And this was not a flimsy study. It was detailed and in-depth; 5,300 claims of all types--physician and hospital services, home health care, lab tests--were thoroughly audited. Patient medical records were reviewed and providers and beneficiaries were interviewed. Fully one third of all the claims were found to contain mispayments--all or a portion of the claims should not have been paid. Some 46 percent of the mispayments were for claims that had either inadequate or no documentation to justify their need; 36 percent of the payment errors involved services that upon review were found not medically necessary. For example, Medicare was charged for x rays on both knees for one patient, when the patient only had problems with one knee. And 8 percent of the payment errors were due to improper billing codes used by health care providers. For example, a physician billed for one office procedure when upon review of the medical records it was found another less expensive procedure was actually performed. This report is a devastating indictment of the administration of Medicare. And if it goes unaddressed, Medicare will lose as much money over the next 5 years to fraud, waste, and abuse as was cut by the balanced budget act we just passed. That is simply unacceptable. Making sure that doesn't happen should be at the top of the priority list for the Department of Health and Human Services and this administration. I am afraid, however, that this may not be the case. The Department has drafted a corrective action plan that, if fully implemented, would take some important steps to addressing the problems identified in the CFO audit. My understanding is that it calls for a 10-percent increase in medical reviews, a 20-percent increase in prepayment review of hospital claims, a 20-percent increase in post- payment review of physician claims, and increases in provider education, expanded audits of home health agencies and nursing, and other improvements. These are important improvements, but they are woefully inadequate. We need to at least double the number of audits Medicare is conducting. Right now, only about 3 percent of claims are reviewed and only 3 of every 1,000 providers receive a comprehensive audit in any year. That needs to change. And this amendment would help Medicare meet this need. I send an amendment to the desk for myself and Senator Graham of Florida, who has been tireless in the fight against Medicare fraud, and ask for its immediate consideration. This amendment would direct the Department of Health and Human Services to obligate no less than an addition $50 million this fiscal year to increase Medicare audits and to comply with its correction action plan developed in response to the CFO audit. Mr. President, there is about $53 million in the Medicare contractor account for fiscal year 1997 that will likely go unspent. This is due to problems the Department has encountered in the administration of its Medicare transaction system [MTS] initiative. Rather than seeing this money lapse or be rushed inefficiently into a last minute contract, our amendment would assure that this money is well spent to address a pressing problem. It would be easy for the Department to implement because it would simply obligate it to existing contractors to expand the number of audits and reviews that they undertake--it will simply, in effect, increase a current work order. Mr. President, it would be unconscionable for the Department to let these funds lapse when they know how inadequate their current efforts and resources are to combat Medicare fraud, waste, and abuse. This is not time for bureaucratic business as usual. We need to take bold action to begin to turn the tide against these losses. Our amendment is a simple, commonsense step that would have a significant impact. If properly implemented, it would more than double the percentage of problem providers receiving comprehensive audits. This would save Medicare and taxpayers many times over its costs. I understand the amendment has been cleared on both sides. I urge its adoption.

Mr. HARKIN. Mr. President, I offer an amendment on behalf of Senator Graham, who is proposing this on behalf of Senators Kennedy and Abraham. I also lend my support to the measure. I understand it also has been accepted by both sides. This has to do with immigration.

Mr. HARKIN. Mr. President, I ask unanimous consent that reading of the amendment be dispensed with.

Mr. HARKIN. Mr. President, I understand that amendment has been agreed to.

Mr. HARKIN. Mr. President, I ask unanimous consent that reading of the amendment be dispensed with.

Mr. HARKIN. Mr. President I have another amendment to send to the desk.

Mr. HARKIN. This amendment has been cleared on both sides.