Strengthening Enforcement for Health Care Fraud Crimes Act of 2009

Mr. President, today I introduced legislation to create a national strategy for treating two diseases that affect millions of Americans: depression and bipolar disorders. This bill, the Establishing a Network of Health-Advancing National Centers of Excellence for Depression, or the ENHANCED Act, will establish a network of national centers of excellence for the treatment of these disabling conditions. My bill would increase the number of people with depressive disorders who receive appropriate and evidence-based treatment; it would create a national resource to develop and disseminate evidence-based interventions, and provide public and professional education aimed at eradicating the stigma associated with depressive and bipolar disorders.

Depression and bipolar disorders affect one of every five people in the United States and are the leading cause of disability among individuals between the ages of 15 and 44. In fact, more Americans suffer from depression, bipolar illness and other mood disorders than from coronary heart disease and cancer combined.

Depression can affect anyone, at any age, at any time. It affects children, adolescents, and adults. It affects people of all racial, ethnic, religious, and socioeconomic levels as well as both sexes. Young adults, women of childbearing age, people with chronic medical conditions such as diabetes and heart disease, and adults over the age of 55 are at especially high risk of depression.

With medication, psychotherapy, or combined treatment, most people with depression and mood disorders can be effectively treated and resume productive lives. Yet one-third of those suffering from depression--nearly 5 million Americans--do not receive treatment because they cannot afford it, do not believe it is needed, are afraid of societal judgment, or do not know where to go.

My bill is based on work done informally by 16 academic research institutions across the nation. Led by my own State's University of Michigan Depression Center, these comprehensive research and treatment centers have joined together to create a network of depression centers positioned to take academic research and translate it into practice, standardize diagnoses, treat early and more effectively, and prevent recurrences of depression and bipolar disorders.

Currently, there is no direct federal support or coordination of this work. Clinicians lack universally accepted multi-disciplinary approaches and real-time clinical and care management guidelines. Nearly half of all diagnoses of depression and bipolar are missed. And tragically, one of the preventable costs of undiagnosed, untreated and undertreated depression is suicide. The World Health Organization recently reported that suicide causes more deaths around the world every year than homicide or war. Across all age groups nationwide, more than 90 percent of those who commit suicide have a diagnosable psychiatric illness at the time of death: usually depression, alcohol abuse or both. Clearly, we need better diagnostic approaches to depression in primary care, other medical settings, and mental health programs.

Finally, depression has a significant economic impact on society. The estimated total annual cost of depression in the U.S. is $83.1 billion, with the majority of costs in the form of reduced productivity, absenteeism, and mortality.

The ENHANCED Act offers us a viable response to a devastating and often debilitating disease: it would create a national network with a pathway for developing and expanding up to 30 depression centers of excellence with a goal of increasing access to the most appropriate and evidence-based depression care; it would develop and disseminate evidence-based treatment standards, clinical guidelines, and protocols to improve accurate and timely diagnosis of depression and bipolar disorders; it would expand multidisciplinary, translational, and patient-oriented research by fostering the collaboration of academic and community-based organizations; and, it would establish a sustainable national resource for public and professional education and training.

We need to act now to make effective and evidence-based treatment of depressive and bipolar disorders available to the millions of Americans suffering from depression.

I urge my colleagues to join me today to support the ENHANCED Act.

Mr. President, I ask unanimous consent that letters of support be printed in the Record.

Mr. President, I rise today to commemorate a defining moment in our Nation's history--the American Civil War. From 1861-1865, the U.S. was torn apart, engaged in the most deadly struggle that has ever befallen our great Nation. As we approach the War's 150th anniversary, we must remember the contributions of our forefathers, those many Americans who gave their lives to make America what it is now. Today I join my colleague, Senator Webb, in introducing the Civil War Sesquicentennial Commission Act of 2009.

We all studied the Civil War in school. We know that the opening shots of the Civil War were fired at Fort Sumter, South Carolina in April of 1861 and that Robert E. Lee and Ulysses S. Grant agreed to peace at Appomattox Court House, Virginia on April 9, 1865. We recognize those most horrific battles--Antietam, Gettysburg, Fredericksburg, and the 10,000 other sites from New Mexico to Vermont that were host to fighting. We celebrate the strength and bravery of individuals such as Frederick Douglas and Harriett Tubman who risked everything to combat the deplorable institution of slavery. Every February, we observe President Lincoln's birthday, a day to recollect his legacy. The Emancipation Proclamation and Gettysburg address are two of the most memorable documents in American history, and it is thanks to President Lincoln that slavery was eradicated.

These are the most memorable aspects of the Civil War, but the influence and impact reaches so much further. I recently learned that on this very day, 148 years ago, work was underway on a revolutionary new technology--an innovation that would forever change the face of naval warfare. It was in October of 1861 that the keel of the USS Monitor was laid. For those who may not remember, the USS Monitor was the world's first ship to be entirely constructed from iron. It also featured the first rotating gun turret, allowing it to fire in any direction regardless of which way the ship was facing. Naval history recognizes this as the beginning of the end for wooden warships and the need to strategically position ships because their artillery could only be fired in one direction. I recognize this as an example of American ingenuity.

This is just one additional example to show how the events of the American Civil War have reverberated through history. Every aspect of American life was affected whether economic, cultural, political, or otherwise. The most profound consequence of the Civil War was to end the legal edifice that justified the subjugation of people based on accidental characteristics such as race.

We must remember what our forefathers sacrificed for us. More than 3 million men fought in the Civil War. They left their homes and their loved ones to fight for their beliefs, their families, their Nation. 620,000 of those soldiers gave their lives.

We must remember the untold number of civilians who lost their lives or welfare because the battles were taking place all around them. No State, city, community, or family was untouched by devastation or loss.

We must remember the legacies of the Civil War. The U.S. emerged completely altered after the 4 years of struggle, and as a testament of American resilience, grew stronger than it was before. The cultural and political ramifications still shape the American landscape today. It was in the era of Reconstruction that Congress adopted the 13th, 14th, and 15th amendments to the Constitution, acknowledging black Americans as free and equal citizens of the U.S.

The Civil War Sesquicentennial Commission Act of 2009 is about preserving the memory. It will establish a Commission to ensure suitable National observance. Consisting of 25 members from government, business and academia, this commission will develop and carry out programs to commemorate the 150th anniversary of the Civil War. It will work together with State and local governments, as well as various organizations, to assist with these activities and ensure that remembrance occurs at every level.

Mr. President, 2011 marks the anniversary of a monumentally tragic time in American history, but also a time of intensive change, growth, and hope. We must use this opportunity to reflect upon the Civil War, the sacrifices, legacies, and changes in our Nation. I urge support of the Civil War Sesquicentennial Commission Act of 2009.

Mr. President, today I am pleased to introduce legislation that would prohibit the Federal Communications Commission from enacting rules that would seek to regulate the Internet. Today the commission will meet to determine whether the historically open architecture and free flow of the Internet should be subject to onerous Federal regulation. Specifically, the commission will seek to impose ``net neutrality'' rules that would reign in the network management practices of all Internet service providers, including wireless phone companies.

Skeptical consumers should rightly view these new rules as yet another government power grab over a private service provided by a private company in a competitive marketplace. Earlier this year the administration moved to control much of the auto industry and the banking industry and now the administration is trying to control the technology industry by regulating its very core: the Internet.

This government takeover of the Internet will stifle innovation, in turn slowing our economic turnaround and further depressing an already anemic job market. Outside of health care, the technology industry is the nation's fastest growing job market. Innovation and job growth in this sector of our economy is the key to America's future prosperity. In 2008, while most industries were slashing jobs in the worst economy in nearly 30 years, high tech industries actually added over 77,000 good high-paying jobs. Just this month, Google and Yahoo both released positive earnings reports.

According to a report released last week by the Recovery Accountability and Transparency Board, which oversees the stimulus plan, 30,000 jobs have been directly created or saved by contractors who received money from the $787 billion stimulus package for infrastructure and social programs. This pales in comparison to the fact that the high tech industry produced more than double the number of jobs so far ``created or saved'' by the so-called ``stimulus legislation.'' It did so without the assistance of $787 billion from the wallets of taxpayers. Maybe a better stimulus package for this economy would be an administration decision to keep the Internet free of government control and regulation.

Unfortunately, the administration seems oblivious to the fact that their stated opposition to the supposed excesses of capitalism is at odds with a new regulatory regime being lobbied for by the most powerful businesses. As the Chairman of the Federal Communications Commission has recognized, Americans have benefitted enormously from the Internet's ``fundamental architecture of openness.'' The light touch regulatory approach toward the Internet that was advanced by previous administrations has brought Americans social networking, low cost long distance calling, texting, telemedicine and over 85,000 ``apps'' for the iPhone. It also brought us Twitter, You Tube, Hulu, Kindle, the Blackberry and the Palm. It has allowed the Internet to change our lives forever.

The wireless industry exploded over the past twenty years due to limited government regulation. Wireless carriers invested $100 billion in infrastructure and development over the past three years which has led to faster networks, more competitors in the marketplace and lower prices compared to

any other country. Meanwhile, wired telephones and networks have become a slow dying breed as they are mired in state and Federal regulations, universal service contribution requirements and limitations on use.

It is for these reasons that today I introduce The Internet Freedom Act of 2009 that will keep the Internet free from government control and regulation. This will allow for continued innovation that will in turn create more high-paying jobs for the millions of Americans who are out of work or seeking new employment. Keeping businesses free from oppressive regulations is the best stimulus for the current economy.

Mr. President, I have sought recognition to speak about the Strengthening Enforcement for Health Care Fraud Crimes Act of 2009, which I am introducing today with Senator Graham.

At a time when Congress is poised to pass historic health care reform legislation to protect the health of Americans, it is imperative that we do all that we can to eliminate waste, fraud and abuse in America's health care systems. We must do all that we can to prevent, detect and vigorously prosecute health care fraud.

Health care fraud costs tax payers billions of dollars each year. National health care spending in the United States exceeded $2.2 trillion and represented 16 percent of the Nation's Gross Domestic Product in 2007. The National Health Care Anti-Fraud Association, NHCAA, conservatively estimates that 3 percent of all health care spending--or more than $60 billion--is lost to health care fraud perpetrated against both public and private health plans. Other estimates by government and law enforcement agencies suggest losses from fraud as high as 10 percent--or $220 billion annually.

Fraud committed against both public and private plans by health care providers, medical equipment suppliers, drug companies, and also by fraudulent plan operators and brokers, undermines public trust in our health care system.

More importantly, the costs of health care fraud are borne by all Americans. It does not matter if you have health insurance sponsored by your employer, if you purchase privately your own insurance policy, or pay taxes to fund government health care programs. Health care fraud results in reduced benefits and coverage, and higher premiums and costs. It can mean higher taxes and increased budgetary challenges.

Health care fraud often targets the most vulnerable in our society-- the elderly, the poor, and the infirm. Criminals involved in health care fraud falsify patients' medical records and steal patients' personal and insurance information to submit fraudulent claims. Health care fraud subjects patients to unnecessary and dangerous medical procedures. According to the FBI:

One of the most significant trends observed in recent

health care fraud cases includes the willingness of medical

professionals to risk patient harm in their schemes. FBI

investigations in several offices are focusing on subjects

who conduct unnecessary surgeries, prescribe dangerous drugs

without medical necessity, and engage in abusive or sub-

standard care practices.

FBI Financial Crimes Report to the Public, Fiscal year 2007.

Criminologists have long reported that criminals look at three factors in performing their own cost benefit analysis: the risk of getting caught; the probability of being convicted; and the severity of the punishment.

The bill I am introducing today addresses the third factor--and sends the message loud and clear to those who would contemplate committing health

care fraud. If caught stealing $100,000 or more you will go to jail--no ifs, ands or buts. The bill provides a sentence of at least 6 months incarceration for committing health care fraud with losses of $100,000 or more. You may even get more jail--under the discretionary guidelines--but no one will get less than 6 months for schemes of this size.

Since the Supreme Court decided United States v. Booker in January 2005 and made the Sentencing Guidelines advisory, sentencing judges have wide discretion to impose sentences on criminal defendants unless mandatory minimum sentences are applicable. Except for aggravated identity theft crimes, defendants do not face mandatory imprisonment for white collar crimes. Given the importance and necessity to vigorously prosecute and punish serious health care fraud crimes, I urge the Senate to pass this bill. Without it, there will be no certainty of punishment nor effective deterrence for serious health care fraud crimes.

Mr. President, I have sought recognition to speak about the Strengthening Enforcement for Health Care Fraud Crimes Act of 2009, which I am introducing today with Senator Graham.

At a time when Congress is poised to pass historic health care reform legislation to protect the health of Americans, it is imperative that we do all that we can to eliminate waste, fraud and abuse in America's health care systems. We must do all that we can to prevent, detect and vigorously prosecute health care fraud.

Health care fraud costs tax payers billions of dollars each year. National health care spending in the United States exceeded $2.2 trillion and represented 16 percent of the Nation's Gross Domestic Product in 2007. The National Health Care Anti-Fraud Association, NHCAA, conservatively estimates that 3 percent of all health care spending--or more than $60 billion--is lost to health care fraud perpetrated against both public and private health plans. Other estimates by government and law enforcement agencies suggest losses from fraud as high as 10 percent--or $220 billion annually.

Fraud committed against both public and private plans by health care providers, medical equipment suppliers, drug companies, and also by fraudulent plan operators and brokers, undermines public trust in our health care system.

More importantly, the costs of health care fraud are borne by all Americans. It does not matter if you have health insurance sponsored by your employer, if you purchase privately your own insurance policy, or pay taxes to fund government health care programs. Health care fraud results in reduced benefits and coverage, and higher premiums and costs. It can mean higher taxes and increased budgetary challenges.

Health care fraud often targets the most vulnerable in our society-- the elderly, the poor, and the infirm. Criminals involved in health care fraud falsify patients' medical records and steal patients' personal and insurance information to submit fraudulent claims. Health care fraud subjects patients to unnecessary and dangerous medical procedures. According to the FBI:

One of the most significant trends observed in recent

health care fraud cases includes the willingness of medical

professionals to risk patient harm in their schemes. FBI

investigations in several offices are focusing on subjects

who conduct unnecessary surgeries, prescribe dangerous drugs

without medical necessity, and engage in abusive or sub-

standard care practices.

FBI Financial Crimes Report to the Public, Fiscal year 2007.

Criminologists have long reported that criminals look at three factors in performing their own cost benefit analysis: the risk of getting caught; the probability of being convicted; and the severity of the punishment.

The bill I am introducing today addresses the third factor--and sends the message loud and clear to those who would contemplate committing health

care fraud. If caught stealing $100,000 or more you will go to jail--no ifs, ands or buts. The bill provides a sentence of at least 6 months incarceration for committing health care fraud with losses of $100,000 or more. You may even get more jail--under the discretionary guidelines--but no one will get less than 6 months for schemes of this size.

Since the Supreme Court decided United States v. Booker in January 2005 and made the Sentencing Guidelines advisory, sentencing judges have wide discretion to impose sentences on criminal defendants unless mandatory minimum sentences are applicable. Except for aggravated identity theft crimes, defendants do not face mandatory imprisonment for white collar crimes. Given the importance and necessity to vigorously prosecute and punish serious health care fraud crimes, I urge the Senate to pass this bill. Without it, there will be no certainty of punishment nor effective deterrence for serious health care fraud crimes.