This is an archive page.  The links are no longer being updated.
    
REMARKS BY:	DONNA E. SHALALA, SECRETARY OF HEALTH AND HUMAN SERVICES
PLACE:		National Congress on Health Care Compliance, Washington, D.C.
DATE:		March 9, 2000

Maybe because I'm with so many compliance "heavy hitters," I'm reminded that spring training started just last week for the "boys of summer." As some of you know, I'm quite a baseball fan. A few years ago, I even threw out the first ball on Opening Day for the Orioles. One of my favorite baseball stories involves the legendary Hank Aaron. In 1957, the Milwaukee Braves were playing the New York Yankees in the World Series. When Aaron came up to bat for the Braves, Yogi Berra tried to do what catchers often do with good hitters-Berra tried to rattle him. With a smirk on his face, Berra shouted, "You're holding the bat the wrong way. Turn it around so you can see the trademark." Without missing a beat-and with his eyes still on the ball-Aaron replied, "I didn't come here to read; I came here to hit."

In many ways, when it comes to fighting fraud, waste and abuse, that's been the game plan of the Clinton Administration since we got an earful from Medicare beneficiaries during Health Care Reform. Over the past seven years, we didn't just read about the problem. We didn't just talk about it. We took real action...and just look at the results:

In 1999 alone, we returned nearly 500 million dollars to the Medicare Trust Fund---to Medicare beneficiaries--from health care prosecutions. And in the last three years, we've returned more than 1.6 billion dollars to its rightful owner--the American people. Other efforts to prevent improper and wasteful spending saved taxpayers an estimated 60 billion dollars since 1993. Our ground-breaking "Operation Restore Trust"--which I discussed with you last year-- identified 23 dollars in overpayment for every dollar spent looking for fraud and waste in Medicare and Medicaid. And in the last three years we excluded almost 9,000 individuals and entities, who tried to throw a curve ball and abuse the system, from doing business with federal and state health care programs.

But we didn't stop there. Between 1996 and 1998, improper Medicare payments to hospitals and other health care providers-the Medicare fee-for-service error rate-declined by almost half. This is dramatic improvement. The growth rate of Medicare is also down sharply-and some of this decline is attributed to anti-fraud efforts. Our fight to control fraud and waste has also been cited by the Medicare Trustees as one of the reasons that the estimated life of the Trust Fund has been extended by 8 years.

Finally, to continue our work and keep the compliance ball in play, the President's Fiscal Year 2001 budget includes proposals that will save Medicare 7.9 billion dollars over five years by reducing overpayments and fighting waste.

Of course, none of this good news would have been possible without our compliance team members at Justice, the FBI, the Inspector General's Office and other government agencies.without our gifted all-stars like Nancy Ann Min-DeParle at HCFA and June Gibbs Brown-the best Inspector General in Washington...and, of course, without all of you.

Today, I'm happy to say I have two more pieces of good news to report. I'm pleased to announce that--for the very first time in its history--the Department of HHS received an unqualified, or "clean," audit opinion from the Inspector General's Office for our Fiscal Year 1999 financial statements. That means our statements fully meet auditing standards. More important, it means that we are meeting the standards that the American people deserve. This is a significant milestone for all HHS agencies--but especially for HCFA. For the past two years, HCFA has undertaken an unprecedented, multi-year, effort to improve Medicare's financial reporting, accounting and payment systems.

In a separate report, the Inspector General's Office also found that HCFA maintained the phenomenal improvements made in the Medicare error rate--the rate of improper payments made to providers---and met its interim goal of lowering the error rate to 9 percent in 1999. Specifically, the rate held steady in 1999 at 7.97 percent-a statistically insignificant change from the year before. After the dramatic decline in 1998, this was no surprise. But in the year 2000, we want to resume our progress--and the area most begging for improvement is documentation problems among Medicare providers. In 1999, payments found to be improper because of missing or insufficient documentation increased by 3.4 billion dollars over the year before. Let me be clear: This isn't necessarily about fraud. But it's definitely about protecting taxpayers from waste and potential abuse.

The error rate is not a measure of fraud in the Medicare system-it's an estimate of the improper claims made to the program. According to the report, virtually all claims examined were paid-correctly-by Medicare, based on the information submitted by providers. Unfortunately, many claims were based on insufficient or missing documentation. To improve documentation.to further reduce the error rate in Fiscal Year 2000.and to ensure that we keep the promise of Medicare for future generations, HCFA has launched several new initiatives, including: Tracking the payment accuracy for each claims-processing contractor; revising documentation guidelines for physicians; and expanding its provider education campaign. I have no doubt that these, and other, initiatives will build on our accomplishments that are not only saving precious dollars but--in the long run--saving precious lives.

It's true that we've come a long way in fighting health care fraud, waste and abuse over the past seven years. But this is no time to be complacent-the game is far from over. I think of it as being in the seventh inning stretch. It's a time to stand up and take stock of how far we've come-but also to think about what we need to do to win the game. When it comes to baseball, you need the right combination of offense and defense. When it comes to fighting fraud, waste and abuse, you need the right combination of enforcement and prevention. That's exactly the strategy we're going to pursue.

In other words, we're going to cooperate with providers who genuinely desire to comply with Medicare and other requirements. And we're going to come down hard on those who do not. Government regulation- enforcement-is an important weapon in the fight against fraud and abuse. But let me be very clear: We start from the assumption that people in the health care business are trustworthy. They're honest. And they want what we want: Good quality health care for all. But for the few who seek to abuse the system: We have a powerful arsenal at our disposal. For example, the Health Insurance Portability and Accountability Act of 1996 provides a steady funding stream to ensure that we have the resources to stop waste, fraud and abuse.

However, while we will vigorously practice enforcement-we favor prevention. By that I mean voluntary compliance with all rules and regulations. I firmly believe that most health care workers and companies want to cover all the bases and voluntarily comply with regulations and requirements. In the great baseball movie, Field of Dreams, Kevin Costner was told that "If you build it, they will come." Well, we are building compliance control programs--and we've seen that the health care community is responding. For example, the number of health care providers who have come forward and self-disclosed potential violations has significantly increased in just the last two years.

Of course, when it comes to voluntary compliance, we know that none of you can do your jobs by yourselves-and we don't expect you to. We are your partners. Ask us. Talk to us. The Inspector General's Office maintains a website and publishes "compliance program guidances" that are tailored to specific sectors of the health care industry. An eighth compliance guidance-for nursing facilities--will be released later this month. And one for individual and small group physician practices is scheduled for summer publication. HCFA also sponsors various activities-including interactive computer courses-to educate providers about program requirements.

You'll be hearing a lot more about voluntary compliance-including specifics on our guidelines and initiatives- from Deputy Inspector General, Mike Mangano, in a few minutes. He'll also be telling you about a letter that the Office of Inspector General will be issuing today on improving compliance.

I know that voluntary compliance makes our entire health care system stronger and more secure. I know that voluntary compliance-which prevents abuse before it happens-can do more to protect Medicare than even enforcement. And I also know that the ultimate success of voluntary compliance-of prevention- depends on three challenges that I'd like to leave you with today.

The first challenge is for all of you here to convince your colleagues, your co-workers, and your bosses of one truth: Voluntary compliance isn't only in the public interest-it's also in their private interest. It's not just the right thing; it's the smart thing. And it's not just common sense; it's good business sense. Compliance helps protect the reputation of honest providers. Auditing bills and claims-as part of the compliance process-doesn't just uncover over-billing--it also finds under-billing. And fraud investigations and allegations can be extremely disruptive to providers-not to mention costly to fight. In the long run, voluntary compliance isn't just a cost to the bottom line-it's a benefit.

My second challenge to all of you can be summed up in three words: Documentation. Documentation. Documentation. As I mentioned earlier, we can't lower the Medicare error rate if health care professionals don't provide proper and sufficient documentation. As compliance officers, you have the opportunity-and the ability-to guide, inform and educate your providers on the importance of good record keeping and documentation. Spread the word throughout your organization that everyone has a role to play in preventing sloppy billing, over billing and incorrect billing. Ultimately, the less we have to pay for mistakes and errors-the more we can spend where we should: On the beneficiaries.

My third-and final-challenge for all of you is to continue to work together...and to continue to work with all of us-to generate recommendations, innovations and solutions. We need your ideas, your guidance, your support. More than anyone else, you can tell us what you need.what your providers need.and what the health care industry needs.

In fact, when I think about the role each of you must play in health care compliance, I'm reminded of another baseball story--this one about the great manager, Casey Stengal. In 1958, Stengal was asked how he felt about winning the World Series. He thought a moment. He stroked his chin. And then he said, "Well, I couldn't have done it without my players." Similarly, we can't successfully fight fraud, waste and abuse without each and every one of you. You are the experts. You are the watchdogs. You know the best practices. And you're executing the ultimate triple play: You're promoting our common goal of honesty in health care. You're protecting older Americans. And you're preserving the integrity of publicly funded health care for America's future generations.