Good morning, Mr. Chairman. I am Michael F. Mangano, Principal Deputy
Inspector General of the Department of Health and Human Services, and I am here
to report to you on our efforts to combat fraud, waste, and abuse in the
Medicare program.
Medicare is one of our nation's most important social programs. It provides
health care coverage for more than 38 million elderly or disabled Americans.
Unfortunately, it also presents many opportunities for unscrupulous individuals
to steal from U.S. taxpayers. Because of the huge sums of money being spent in
support of Medicare-419 1 billion estimated for FY 1997-- there will always be
individuals or companies that attempt to game the program purely for their own
profit. We in the Office of the Inspector General have literally been waging a
continuous war against this fraud and abuse since 1977.
Since last October, the Office of Inspector General and the Department of
Justice have been involved in the resolution of over 700 criminal and civil
cases that have led to settlements of over $1 billion for the Medicare Trust
Fund, and we have excluded over 980 fraudulent and abusive providers from
program participation. Once a program exclusion is imposed, Federal program
payments may not be made to any individual, business or facility for items or
services furnished, ordered, or prescribed by the excluded individual or entity.
Exclusions imposed by the OIG apply not only for HHS and State health care
programs, but also for all other Executive Branch procurement and non-
procurement programs and activities. This means, for example, that a health care
provider excluded from Medicare, Medicaid, and other State health care programs
will be unable to continue participating in the Civilian Health and Medical
Program of the Uniformed Services (CHAMPUS) program administered by the
Department of Defense or in the Federal Employee Health Benefits Program (FEHBP)
administered by the Office of Personnel Management.
Convicting abusive providers, keeping them out of the program, levying
fines, recovering overpayments, negotiating settlements--all these actions are
necessary to reduce Medicare fraud and abuse. But they will never be more than
the second best way to do this. The best way is to prevent fraud, waste, and
abuse from ever occurring in the first place. This requires identification and
correction of vulnerability built into the programs themselves or into the
management systems used to administer and monitor them. We find that most health
care providers are honest. Only a few set out with intent to defraud the
program. However, systemic weaknesses create gray areas that make Medicare
vulnerable to abusive and improper billings, increasing the risk of improper
payments.
Vulnerability to Abusive and Improper Billings
One source of vulnerability is the design of the benefit categories and
reimbursement criteria themselves. Our audits, investigations, and evaluations
often reveal patterns of unintended incentives, inherently ineffective controls,
poorly defined eligibility criteria, excessive reimbursement rates, unmeasurable
outcomes, baselines premised on inaccurate assumptions, and other such design
weaknesses. When we spot these kinds of problems, we issue reports recommending
regulatory or legislative reforms. Our office has testified before the Congress
on many of these problems. Based on a review of all of our work in recent years,
I would like to highlight here what we believe are the areas of highest risk for
abusive and improper billings to the Medicare program.
Home Health. Between 1990 and 1996, expenditures for home health benefits
had grown fivefold from $3.5 to $16.9 billion, and the number of beneficiaries
increased from 2 to 3.7 million. Utilization also doubled, from an average of
36 to 76 visits per beneficiary. Some of the growth is appropriate and expected
due to changes made to the benefit, demographic trends, technological advances,
and a trend toward providing more care in the community instead of in
institutions.
Unfortunately, fraud and abuse may also be a factor. Recently completed
audits of eight home health agencies (HHAs) in Florida, Pennsylvania, and
California have revealed that from 19 to 64 percent of the home health visits
paid for by Medicare did not meet Medicare guidelines. We found visits that were
not considered reasonable or necessary, patients who were not homebound,
inadequate physician authorization, and services claimed but not provided.
Preliminary results from a study in four of the largest States confirm these
conditions are wide-spread. Following are a couple of examples of fraud and
abuse in the home health industry: False Cost Reports. First American Health
Care of Georgia, Inc. was the largest privately held home health care provider
in the country. When our investigation began, the company was known as ABC Home
Health. Jack and Margie Mills were the majority shareholders and chief officers
of the company and its subsidiaries. After extensive investigation and audits by
the Office of Inspector General, the Mills and the First American parent company
were convicted of several Medicare-related criminal offenses and were excluded
from participating in the Medicare and Medicaid programs. The Mills' received
significant prison time, and the related settlement provides for a return of
$255 million to the United States. Offenses included improperly shifting
unallowable costs onto Medicare cost reports such as lobbying and advertising
expenses and promotional items such as $84,000 in gourmet popcorn. The company
and its owners claimed items and services that benefitted the owners personally
as reasonable and necessary "general and administrative" expenses related to the
care of Medicare patients (e.g., golf course memberships, greens fees, a family
vacation, and an expensive car for a son in college).
Services Not Rendered. On a smaller scale, the co-owner of a Washington,
D.C. HHA was sentenced to 27 months in prison and ordered to pay full
restitution of $100,000 defrauded from the Medicare and Medicaid programs. The
HHA billed for 1,450 skilled nursing visits for which there are neither time
slips nor nurses' notes documenting the visits were made. It also billed for
home nurse visits when patients were actually hospitalized. Another co-owner was
also convicted but has been in escape status since leaving his detention center
assignment.
We have also found extreme and seemingly unjustifiable variation in payments
to home health agencies. In 1994, lower cost home health agencies (those which
provided less than the national average of visits per episode) averaged 33
visits per episode, whereas the higher cost agencies (those with visits per
episode above the national average) average 102. Based on our studies, we
believe the differences are due mostly to the discretion afforded home health
agencies to influence the amount of care given to their clients.
We believe that the Health Care Financing Administration can strengthen
controls of the home health benefit through several methods like restructuring
the HHA reimbursement methodology by establishing a prospective payment system;
placing a limit on the number of visits allowed per beneficiary; establishing a
system of pre-authorizations; and/or establishing a copayment. In addition,
programmatic operational actions can be taken such as emphasizing key policy
points in the Medicare HHA manual and improving guidance; revising Medicare
regulations to require the physician to examine the patient before ordering home
health services; requiring intermediaries to provide beneficiaries with
explanations of Medicare benefits for home health services so they can see the
visits being charged to Medicare; and instructing intermediaries to augment
focused medical reviews with physician and beneficiary interviews. HCFA should
ensure more effective reviews of home health agencies, use of case management,
and adequate funding for fiscal intermediaries to detect inappropriate claims.
I would like to note that this subcommittee issued a report back in 1981 on
home health that recommended, as we are recommending today, that HHAs should be
reimbursed under a prospective payment system. The subcommittee believed that a
prospective payment system would force HHAs to be more cost- efficient in
order to meet the target rate. In the absence of a prospective payment system,
the subcommittee recommended that HCFA take a variety of actions including
competitive bidding of subcontracts, competitive selection of intermediaries,
and expediting regulations to require bonding of HHAs in their first 5 years of
operations or under certain other conditions. The subcommittee encouraged
increased intermediary audits of HHAs, better notification of HHAs regarding
policy changes, and asked HCFA to pursue the use of termination and exclusions.
Medical Equipment and Supplies. Over the years, we have devoted significant
resources to issues involving medical equipment and supplies. The problems have
included claims for equipment that was never delivered, upcoding, unbundling,
medically unnecessary equipment, and excessive payment rates. Our work has
disclosed losses totaling several hundred million dollars for incontinence
supplies, wound care, lymphedema pumps, and orthotic body jackets. We previously
found abuses relating to seat lift chairs and power operated vehicles.
The widespread problems in this area have been due in part to high profit
margins, ease of entry into the system, and weaknesses in payment safeguard
functions. We believe that legislative and regulatory actions are needed to
tighten up entry of suppliers into the Medicare program, and to give the Health
Care Financing Administration greater authority to set prices for equipment and
supplies. However, such authorities are needed throughout the Medicare program,
not just in the area of supplies and equipment.
A specific area of concern is the home oxygen benefit. For beneficiaries who
are deficient in the amount of oxygen in their blood, Medicare covers both
oxygen and oxygen supplies and equipment, including the system for furnishing
it, the vessels that store it, and the tubing and administration sets.
Allowances more than doubled from 1992 to 1995, rising from $835 million to more
than $1.6 billion. The root of the problem is not so much with billing abuses as
with the fact that Medicare cannot get competitive prices. Even though it is a
high-volume payer, Medicare is not able to negotiate volume prices as
high-volume purchasers normally do. Medicare paid more than twice as much for
oxygen equipment and supplies as the Department of Veterans Affairs according to
our 1991 study. The difference remains greater than 40 percent in 1996. The
Health Care Financing Administration estimated the savings could be at least
$200 million per year from a 40-percent reduction on reimbursement for oxygen
concentrators. In May 1997, the General Accounting Office (GAO) issued a report
comparing Medicare and VA payments for home oxygen supplies and services and
concluded that if Medicare had paid for oxygen and related supplies and services
at the adjusted VA rates, the Medicare program would have saved as much as $500
million in FY 1996. The VA uses competitive bidding to lower its costs. Medicare
does not have that option. Legislative options include allowing for competitive
bidding or setting special payment limits.
Other program weaknesses create conditions in which Medicare pays more than
it should, pays inappropriately, or pays improperly because of false billings. I
would like to describe some examples of fraud in the medical equipment and
supplies arena:
Incontinence Supplies. One of the highest-reimbursed Medicare suppliers of
incontinence care products agreed to plead guilty to conspiracy to defraud
Medicare of more than $70 million. He distributed adult diapers to nursing homes
(which are not covered by Medicare) but billed Medicare for female urinary
collection pouches. He agreed to forfeit $32 million in seized bank accounts,
paid $2.5 million in restitution, and was sentenced to 10 years imprisonment.
Another incontinence care supplier defrauded Medicare of $25 million, forfeited
$12 million, and was sentenced to 57 months incarceration followed by 3 years
supervised release.
Durable Medical Equipment. At least 19 individuals have been convicted in
connection with over $20 million in false billings of durable medical equipment
and supplies by a major supplier and related companies. The individuals were
owners, physicians, sales people, and an accountant. The physicians were charged
with signing medical necessity forms for equipment which was never received or
needed, without seeing the patients. The sales people were charged with
recruiting Medicare beneficiaries by giving them nonreimbursable items such as
microwaves and air conditioners, while the company billed Medicare for
reimbursable items such as hospital beds and wheelchairs. Several sales people
were Russian or Hispanic and were targeting Russian and Spanish- speaking
beneficiaries. One physician who was sentenced in absentia fled to the Dominican
Republic and cannot be extradited at this time.
Lymphedema Pumps. These pumps are pneumatic compression devices that are
used to treat swelling of tissues resulting from accumulation of fluid from
lymphatic blockages. The pumps range in sophistication and can cost from $600 to
$6000. One supplier was sentenced to 1 year in prison and 3 years supervised
release and was ordered to pay $294,860 in restitution, fines, and penalties. He
billed Medicare for lymphedema pumps at $4,500 each, but he delivered pumps that
would have been reimbursed at $600 and pocketed the difference.
Nursing Homes and Related Services. The Medicare and Medicaid programs
together paid $46 billion for nursing care of all kinds in 1995. This included
$42 billion in payments to nursing homes ($9 billion under Medicare Part A and
$33 billion under Medicaid), and $4 billion under Medicare Part B in payments to
various providers of medical supplies and services for Medicare beneficiaries
residing in nursing homes.
We have found a variety-of problems including inappropriate billings for
mental health services for patients in nursing homes. At least $17 million, or
24 percent of all such billings, were in error in 1993. This included payments
for socialization events billed as group therapy and payments for psychotherapy
sessions for individuals not needing them and with diminished capacity to gain
any benefit from them. Following are two examples of inappropriate billings for
mental health services to nursing home residents:
Psychology Services. A company which employed psychologists to provide
services to nursing home residents entered a civil settlement agreeing to pay
$700,000 to settle allegations that it submitted false Medicare claims. The
company billed for 45 to 50 minutes of psychotherapy to nursing home residents
when only 20- to 30-minute sessions were held. Some of the psychologists billed
for more than 14 hours of therapy a day -- one billed for the equivalent of more
than 24 hours a day.
Psychiatric Services. In another example, a psychiatrist signed an agreement
to pay the Government $300,000 to settle. He provided psychiatric care to
Medicare beneficiaries in nursing homes in California, Rhode Island, Florida,
Texas, New York, Washington and Oregon. His scheme involved duplicate billing
through two separate entities, both of which he owned. During the investigation,
his various companies were found to have 24 different mailing addresses, 23
different telephone numbers, and at least 12 different provider numbers.
We have become increasingly concerned about cost shifting from Medicare Part
A to Medicare Part B in the nursing home setting. Nursing home residents are
accessible and can be vulnerable, providing a unique opportunity for fraud,
waste, and abuse. Unless protected by concerned family or friends, the attending
physician, or enlightened policies and practices of the nursing home, nursing
home residents may be subjected to health care practices in which decisions on
care are governed as much by financial incentives as medical necessity.
We support the idea of a prospective payment system for Medicare Part A
nursing facilities and would also advocate that this or a similar approach be
more widely used by States under their Medicaid programs. We urge that as many
services as possible be included in the prospective payment rate, such as most
payments for enteral nutrition, incontinence supplies, and wound care. Services
which are not included in the prospective payment rate should be consolidated
into a single bill to be submitted by the nursing home under Medicare Part B, if
appropriate.
It is just as important to ensure quality of care as it is to control costs.
Prospective payment systems will bring their own incentives, some of which may
provide a risk to quality of care through premature discharge or refusal to
accept patients with complicated conditions. Therefore, it may be necessary to
include higher payments for outlier cases and anti-dumping provisions similar to
those that apply to hospitals.
Laboratory Services. We are nearing completion of a multi- year
investigative initiative called LabScam. This is targeted at abusive marketing
and billing practices, particularly "unbundling to which is the practice of
running specimens through a single piece of automated multi-channel laboratory
equipment and then billing separately for each component test. So far our
investigation has generated receivables of over $800 million. Initially we
focused our efforts on large, independent laboratories. We are now directing our
attention to hospital outpatient labs. Here are two examples:
Independent Laboratory Case. Smith Kline Beecham Clinical Laboratories was
named in a number of suits related to marketing and billing abuses common to all
the laboratories, including unbundling. Smith Kline entered into a settlement
agreement and a corporate integrity agreement with the Federal Government. The
company agreed to pay $325 million and implement a stringent compliance plan
under the supervision of the Office of Inspector General to settle its civil
liability for false billings.
Hospital Outpatient Laboratories. As a result of a review of hospital
outpatient laboratory billings in one State, we are expecting about 25
settlements amounting to about $10 million. We found that these hospitals were
widely practicing unbundling of tests and submitted erroneous or excessive
claims for urinalysis, organ panel, hematology and automated blood chemistry
tests. This review is being extended nationally.
Fraud is not the only reason laboratory services are rising so rapidly.
Incentives for increased utilization can be found in the practice of defensive
medicine. Much of this is legitimately needed, but some of the increased
utilization may be unnecessary. The frequency of testing for the Medicare
population increased 96 percent from 1986 to 1993, while the population
increased by only 14 percent. For all these reasons, laboratory services is one
area we need to keep a close watch on.
Hospitals. Our short list of potential program vulnerabilities includes the
largest or fastest growing components of the Medicare program. This certainly
includes hospitals, the largest single destination of Medicare payments.
According to the 1997 Annual Report of the Board of Trustees of the Federal
Hospital Insurance Trust Fund, payments for the costs of fee-for-service
inpatient hospital care represented 67 percent of Part A benefits. Based on Part
A benefit payments of $128.6 billion, fee-for-service inpatient care amounted to
$86.2 billion in calendar year 1996. We find a high risk for upcoding of
discharge billings, gaming of the prospective payment window, and using
accounting techniques to exaggerate "losses" upon the sale of facilities and
then billing Medicare for millions of dollars to cover its share of these
spurious losses.
Upcoding of discharge billings. Most hospitals are paid based on a
diagnosis-related group (DRG) code for each discharge under the prospective
payment system. Medicare does not currently have a process in place to validate
the codes and assure proper payment is made. We are studying the use of
commercial software currently used to detect billing irregularities and will
determine the extent to which hospitals are upcoding hospital discharges for
Medicare payment; that is, charging for a higher level of service than was
actually delivered. We are finding upcoding with regard to conditions such as
respiratory illnesses. The incentives and opportunities for upcoding are
enormous, given more than $86 billion in annual reimbursements and the largely
unmonitored billing environment. In our audit of HCFA's financial statements, we
looked at a sample of hospital claims and are very concerned about an apparent
lack of support for the level of DRG being claimed in some cases. More specific
work will ensue from that review.
Prospective payment window. We are finding a substantial number of
overpayments made to hospitals as a result of claims submitted for nonphysician
outpatient services that were already included in the hospital's inpatient
payment under the prospective payment system. Hospitals that submit claims for
the outpatient service in addition to the inpatient admission are, in effect,
submitting duplicate claims for the outpatient services. We have identified
4,660 hospitals that submitted improper billings for such outpatient services.
These hospitals are given the opportunity to enter settlements with the
Government under which their financial exposure is substantially less than if
litigated under the Federal Civil False Claims Act. One of the most important
parts of this project is the stipulation in each settlement agreement that each
hospital will assure compliance with proper billing for future services. The
total anticipated recovery under this nationwide project is approximately $90
million to $110 million over the next 2 years.
Exaggerated losses. When hospitals are sold, Medicare uses a system called
the Recapture Program to account for gains and losses during the sale of
depreciable assets. If the hospital sells for a profit (anything over its
original value less depreciation) Medicare shares in the profit. If the hospital
sells for a loss, Medicare shares in the loss. We are finding that sales are
being artificially structured to report losses; to minimize profits in order to
maximize Medicare payments at the time of the sale; or to minimize Medicare's
recapturing of a portion of the profit.
Managed Care. Also included in this category of vulnerable program areas is
managed care, which has grown rapidly in recent years to include 4.9 million
Medicare beneficiaries, or 13 percent of the total Medicare population. Our
studies have shown that most beneficiaries are satisfied with the care they
receive from their Medicare managed care providers. However, we have found some
indications that some sicker patients, such as dialysis patients and disabled
persons, are far less satisfied and leave these programs at higher rates than
other beneficiaries. In a 1991 study of health maintenance organization (HMO)
marketing practices in Florida, we found that most beneficiaries did not feel
pressured by sales staff and understood the differences between fee-for-service
and managed care arrangements. A few marketing abuses were found such as sales
staff targeting illiterate or otherwise limited beneficiaries and talking them
into changing from one HMO to another without the beneficiary fully
understanding what they had done. For example, one beneficiary said a driver
picked him up to keep a medical appointment at his HMO. However, the driver took
the beneficiary to a new HMO, whereupon he was enrolled in that HMO plan. The
beneficiary thought he was merely keeping his appointment with is current HMO. A
substantial number of beneficiaries did not understand that they had a right to
back out of managed care if they were not satisfied. Subsequently, we have found
weaknesses with appeal and grievance processes and have uncovered instances of
false billings for institutionalized, dialysis, or Medicaid eligible Medicare
beneficiaries on whose behalf the Medicare health maintenance organizations are
entitled to a higher rate of reimbursement than other members.
Other Vulnerable Areas. Physicians billing for services not rendered or not
needed is a continuing problem. For example, a urologist was recently sentenced
to 24 months in prison for submitting false claims for complex procedures he did
not perform. He will be excluded from Medicare for 10 years because of
aggravating circumstances: i.e., he performed invasive procedures such as visual
examinations of the bladder and urethra and assessments of the bladder's
neuromuscular function which he admitted were not medically necessary. He has
surrendered his medical license.
We are also becoming increasingly concerned about ambulance services. The
Medicare bill has now reached $2 billion per year. We have seen a continuous
stream of fraud cases involving false or inflated claims and billing for higher
levels of service than provided by ambulance companies. We are also just now
seeing a consolidation of that industry into the hands of a few large
corporations. Recently, an ambulance company entered a global settlement of
allegations that it billed the Government for nonallowable transportation
services. The company agreed to forfeit $4.6 million in payments withheld by the
Medicare carrier. Criminal investigation of several individuals is ongoing.
Management Authorities and Systems
Some of Medicare's most troublesome vulnerabilities stem not so much from
the design of individual benefit categories, but from weaknesses in management
authorities or ineffective information and control systems used by the
Department to administer programs and monitor their cost and effectiveness. The
following are examples of such weaknesses which we have observed over and over
again in our work.
Enrollment of Providers. In my earlier discussion of durable medical
equipment, I alluded to the need for stronger measures related to the enrollment
of providers. This is true for almost all aspects of the Medicare program. One
of the best ways to prevent Medicare fraud is to keep illegitimate providers
from ever getting into the program.
This could be accomplished by mandating providers to supply social security
numbers and, in the instances of entities, by supplying tax identification
numbers. The Health Insurance Portability and Accountability Act also
establishes a National Provider Identifier which will be used by all health care
providers and will replace most provider numbers currently used by Medicare.
This can lead to a significant improvement in our ability to identify providers,
and we plan to monitor the implementation of this closely to ensure that there
are adequate provisions to ensure the integrity of the system. However, I also
need to stress to you today that the effectiveness of this new system may be
limited by the statutory prohibition on the collection of Social Security
numbers. We strongly recommend that the Congress authorize the collection of
this information to ensure that fraudulent providers are identified and
prevented from doing business with the Government.
Provider enrollment applications should be updated every 2 years. Other
controls such as use of surety bonds and application fees to pay for on-site
inspections and screening of applicants are also being considered as measures to
strengthen the integrity of the system. In addition, changes are needed to
prevent fraudulent providers from escaping the consequences of their
illegitimate acts by declaring bankruptcy because of the fines imposed on them
or disingenuously passing ownership of their companies on to family members or
friends while continuing to manage the companies from behind the scenes.
Faster Decision Making. We all have had unsatisfactory experiences dealing
with the complexity and size of our Government programs. Changing them is always
difficult. In fact, the system of checks and balances of our government is
designed in part to ensure that change occurs deliberately and cautiously.
While we all can get frustrated with attempting to enact change, I can tell you
that in fighting fraud and abuse, it is particularly disconcerting. In many
respects, the Government is too slow to correct program deficiencies or close
loopholes in the law which allow our programs to be abused. Program managers
need more flexibility in running the programs in order to correct deficiencies
before they result in millions of dollars being wasted. I would like to give you
a couple of examples of this.
Reimbursement rates. When we find that a particular service or piece of
medical equipment is overpriced, the Health Care Financing Administration has to
go through an elaborate rulemaking process to reduce the amount Medicare pays
for that item. This process involves an independent review to determine that the
price of the item is "inherently unreasonable," publication of a proposed rule
in the Federal Register, followed by a response to public comments and the
publication of a final rule in the Federal Register. This process can easily
take 2 years. For example, in December 1992, we reported that Medicare fee
schedules for blood glucose monitors were excessive. While the monitors could be
purchased for $50 at a drug or grocery store, we found that the Medicare fee
schedules nationwide ranged from $144 to $211. In response, HCFA issued a final
rule in January 1995 which established a flat payment amount of $58.71,
resulting in annual savings of $5 million.
Coverage. The same process delays the implementation of decisions about
which services or supplies to cover. For example, when we found that seat lift
chairs were being aggressively marketed as a comfortable lounge chair, HCFA
began the arduous, time consuming regulatory process needed to determine whether
to withdraw coverage of this item. Fortunately, the Congress stepped in with
legislation in 1989 to limit coverage to the seat lift mechanism only, and
expenditures dropped from $122 million in 1988 to $14 million in 1991.
The Health Care Financing Administration needs more flexible and efficient
authorities to make decisions about both prices and coverage.
Adequacy of Current Criminal and Civil Enforcement Measures
Last year we got a major boost in our efforts through the Fraud and Abuse
Control Program, a key part of the Health Insurance Portability and
Accountability Act. This program provides much needed resources, stronger
enforcement tools, and a management structure to coordinate the efforts of
numerous fraud fighting units of Federal, State, and local governments. The
Fraud and Abuse Control Program is a creative and far-reaching program to root
out fraud and abuse in the nation's health care system. It amounts to nothing
less than an all out, pitched battle against health care fraud and abuse.
The program is under the joint direction of the Attorney General and the
Secretary of Health and Human Services, working through the Inspector General.
It is designed to provide a framework and resources to coordinate Federal,
State, and local law enforcement efforts. It mandates a comprehensive program of
investigations, audits, and evaluations of health care delivery; authorizes new
criminal, civil, and administrative remedies; requires guidance to the health
care industry about potentially fraudulent health care practices; and
establishes a national data bank to receive and report final adverse actions
imposed against health care providers. The Act also provides an innovative
mechanism to fund these new anti-fraud efforts, thereby assuring that needed
resources are always available for the effort.
The Health Insurance Portability and Accountability Act envisions a fraud
fighting program that coordinates the efforts of a broad array of law
enforcement and health care agencies. And it authorizes funding to support the
strengthening of their methods and the development of new detection and
enforcement techniques. We have already taken aggressive steps to develop such
partnerships and build a national team to combat health care fraud and abuse.
The combined and organized efforts of our partners presents a formidable
obstacle to wrongdoers in the form of an unprecedented, comprehensive,
nationwide program of audits, investigations, program evaluations, and
sanctions.
CONCLUSION
I appreciate the opportunity to appear before you today and share with you
our report from the front lines of our battles against those who would defraud
Medicare, and also to share with you our insights about vulnerabilities and
problems facing us today. We appreciate your support for our efforts, and I
welcome your questions.