Two House subcommittees sat down together yesterday to work on legislation to end fraud and abuse in Medicare and Medicaid programs, considered an essential first step before acting on national health insurance.
In an unusual display of cooperation, the health subcommittees of the Ways and Means and Commerce Committees had worked together to draft a bill, and yesterday began joint hearings on it. Last year they had refused to conduct joint hearings, and some health legislation died by falling in a crack between them.
Chairmen Dan Rostenkowski (D-Ill.) and Paul G. Rogers (D-Fla.) spoke of the cooperative spirit existing between the two subcommittees and with the new Democratic regime at the Department of Health, Education and Welfare.
HEW Secretary Joseph A. Califano Jr., the first witness, said he and President Carter strongly support the objectives of the bill.
The Carter administration, Califano said, is determined to root out fraud and abuse in the Medicare-Medicaid programs. He called doctors and others who defraud the programs "craven profiteers."
The bill would strengthen tools to detect and prosecute fraudulent activity, which reportedly siphons off up to 10 per cent of the $40 billion annual cost of the government's two biggest health programs. It would also increase penalties for conviction from misdemeanor to felony levels.
The administration and congressional committees have decided they must act to clean up the two programs before trying to enact an even larger national health insurance program. Califano yesterday called the pending bill an "essential building block" on the road to national health insurance.
Leonard Woodcock, president of the United Auto Workers and head of the national health insurance lobby, sent a statement endorsing much of the draft bill, but said the better way to provide health care and hold down costs would be to enact a comprehensive health insurance program now.
Califano give these examples of apparent abuse which HEW's audit agency discovered from a review of Medicaid records:
On each of 42 days in a single year one beneficiary had the same prescription filled twice for the same drug at the same drugstore.
During one year there were payments for one Medicaid beneficiary covering 298 prescriptions filled at five drugstores.
During one year, a physician was paid for 5,500 comprehensive office examinations of 2,009 Medicaid patients. According to the records, one patient received 43 comprehensive exams. The physician's total Medicaid billings for the year was $220,800.
One physician was paid $73,000 for 10,500 separate services to 225 Medicaid patients over an 11-month period, including an average of 42 lab tests per patient, compared with the statewide average of three.