House Ways and Means Subcommittee on Oversight Hearing

Good morning, Mr. Chairman and distinguished Members of the Subcommittee. Thank you for the opportunity to testify about fraud, waste and abuse in our Medicare program. My experience working in law enforcement and private practice has taught me that, notwithstanding improvements in enforcement techniques over the past ten years, Medicare remains vulnerable to criminals intent on stealing. Further, fraud will not be reduced or eradicated with a "pay-and-chase" enforcement system that relies on criminal prosecution and civil litigation. To protect Medicare and provide needed care for generations to come, we simply must find a way to stop paying fraudulent claims. As such, the use of predictive analytics and modeling to identify and stop fraudulent payments should be the focus of our efforts.

The overwhelming majority of physicians, nurses, healthcare professionals, and companies in this country work tirelessly and honestly to provide care for Medicare beneficiaries. It should always be noted that fraud is the exception, not the rule. The men and women within the Office of Inspector General in the U.S. Department of Health and Human Services (OIG), the Department of Justice (DOJ), the Federal Bureau of Investigation (FBI), Centers for Medicare & Medicaid Services (CMS) and its contractors, and the state Medicaid Fraud Control Units, should be commended for the work they do to improve and protect the programs. Based on my experience, the government has some of the best and brightest. Yet, notwithstanding these efforts, more can be done to protect taxpayer money.

Fraud control is a difficult business. n1 Those who work to identify fraud are shining a light on what some label a lapse in oversight, and those who fail to identify fraud are promoting the status quo. To move forward with an effective fraud identification, deterrent, and policing system, all constituent governmental agencies need to collaborate on setting key strategic priorities and grow a culture that encourages innovation and information sharing.

via House Ways and Means Subcommittee on Oversight Hearing.