Roskam’s Straightforward Fix to Medicare Fraud

From Representative Peter Roskam’s Office (6th District)…

Predictive modeling technology would save billions

“This is not about donkeys. This is not about elephants. This is not about liberals. This is not about conservatives. This is about being smart and using the technology that is available to us, investing in it and deploying that to the benefit of the taxpayers and the seniors that we’re here to protect.’”

Washington – As much as $60 Billion of Medicare claims every year are fraudulent. Rep. Roskam has a straightforward, commonsense solution to fix this. In fact, even Nancy Ann DeParle, the White House’s Director of Health Reform, called him a few weeks before the healthcare vote to learn why his amendment wasn’t included in the healthcare bill. Roskam’s solution involves the same predictive modeling technology that credit card companies and other financial services institutions use to discover fraudulent payments with amazing success – only 0.047% of their $11 trillion in annual transactions are fraudulent.

Roskam’s White House Letter: “Given that you had expressed support for this idea, and that the White House included it in the President’s draft proposal ahead of the White House Health Summit back in February, it is clear that there is bipartisan agreement on this solution to prevent taxpayer funds from being wasted on fraudulent claims. If in the final analysis my name as the lead is a hindrance to advancing this proposal, I have enclosed an unsigned version of the legislative text that you can forward to another Member of Congress.”

Transcript

“I’m congressman Peter Roskam. I’m here in my office in Washington getting ready to go down to the Ways and Means Committee and actually testifying, myself, on a deal I am proposing.

Right now Medicare pays money out and then chases down later to determine whether or not it’s fraudulent. It doesn’t make a lot of sense to do that and it’s based on old structures and old models, and it’s frankly the way it’s done.

My idea says, let’s not do it that way anymore. Instead, let’s do it the way the credit card companies do it. That is, determine whether a transaction is fraudulent or not at the time of the transaction. This is called real data verification. It is a fairly straightforward kind of thing. Ironically, I had a conversation with the White House before all the healthcare drama, and they agreed with me that it was a good idea, but unfortunately, it did not make it into the Obama Healthcare Bill.

Well my attitude is lets save the money now. According to the experts we can save $65 billion a year—think about that: $65 billion in savings. This is one of these solutions that I think is a long time coming, and for the life of me I cannot figure out why it hasn’t happened.

I’m going to go into Ways and Means and see how it goes.”

“Look at what the credit card companies and the financial services companies have figured out. This predictive modeling evaluating and determining what is likely to be true and what is likely to be accurate.

On a personal note, my wife and I were traveling overseas. I was pick pocketed. Within minutes my credit card company figured out I was not spending $10,000 on stereo equipment on the streets of Budapest. They shut it off in the blink of an eye.

That technology is available to us, and what we can do, I think, is to come together as a committee and say, ‘You know what? This is not about donkeys. This is not about elephants. This is not about liberals. This is not about conservatives. This is about being smart and using the technology that is available to us, investing in it and deploying that to the benefit of the taxpayers and the seniors that we’re here to protect.’”

Roskam Fraud Prevention Bill to Save Taxpayers $65 billion

  • The Roskam bill implements the same proven technologies that credit card companies use to stop fraudulent transactions before they are processed, saving taxpayers more than $65 billion in improper payments.
  • Nearly 10% of all federal healthcare payments are lost to waste, fraud and abuse, totaling some $60 billion each year.
  • Global credit card transactions process more than $11 trillion a year, vastly more than all U.S. health expenditures, and yet the global credit card fraud rate is a miniscule 0.047%.

Roskam Keeps Pushing for Bipartisan Waste, Fraud and Abuse Fix

  • Rep. Roskam was one of nine GOP House leaders to attend the White House Healthcare Summit in February.
  • Roskam’s healthcare fraud amendment was supported by the White House and included in the President’s draft health reform law released before the Summit.
  • White House Health Czar Nancy Ann De Parle called Roskam to support his proposal and ask why it had been rejected on a party-line vote by Democrats in Congress.

Copyright Publius Forum 2001