Center State Project Director Jim Frogue testified before the Senate Special Committee on Aging on May 6, 2009. This hearing examined fraud in the Medicare and Medicaid programs and was titled: Catch Me If You Can: Solutions to STOP Medicare and Medicaid Fraud from Hurting Seniors and Taxpayers . Frogue provided recommendations for reducing this fraud while maintaining a high level of services for providers and patients participating in the Medicare and Medicaid programs. The Committee is chaired by Sen. Herb Kohl; Sen. Mel Martinez is the ranking member.  Read more about event >> 

Read Jim Frogue's Testimony >>
ABC News Special:  Medicare Scam Steals Billions >>

The Center for Health Transformation is developing an approach to improve healthcare quality, lower costs, and ultimately insure every American - and there are hundreds of breakthrough practices and solutions that are proven to do just that.  If we rebuilt government policies to maximize the rate of migration to these practices and solutions, we would be dramatically healthier and would also save an incredible amount of money.  For a full description of each of these healthcare reform priorities, please click here. The key components are:

1. Creating a healthcare system that works, in which the federal government and other healthcare stakeholders consistently migrate to best practices.  We must ensure that health is the driving focus of the health reform debate. The best way to accomplish this is to surface what is actually working today to save lives and save money and then designing public policy to encourage their widespread adoption. Best practices should drive policy—not the other way around. The Center for Health Transformation has compiled a robust collection of best practices that: 1) Improve health and wellness through prevention and personal responsibility; 2) Improve quality, administration and the delivery of care; 3) Lower costs; and/or 4) Expand access to care.  For example, according to the Dartmouth Health Atlas, the definitive authority on healthcare quality and variation, if the 6,000 hospitals in the country provided care at the Intermountain or Mayo standard, Medicare alone would save 30 percent of total spending ever year – with better health outcomes.  We need to make best practice minimum practice. 
2. Building a nationwide electronic system in two phases by the end of President Obama’s administration.  To do anything to transform health—from paying for outcomes to comparative effectiveness to avoiding medical errors—health IT is absolutely essential. No other industry is an antiquated as healthcare.  EHRs and other technologies are the only tools that simultaneously reduce costs while improving care.  We can first make information more accessible through the Web and then electronically connect all stakeholders with interoperable IT.
3. Dramatically reducing healthcare fraud and changing the budget act so the savings can serve as a major pay-for for health information technology and covering the uninsured.  Outright fraud – criminal activity – accounts for as much as 10% of all healthcare spending. That is more than $200 billion every year.  Medicare alone could account for as much as $40 billion a year.  This level of theft and crime can be detected, eliminated, and then prevented with the right kind of electronic resources.  As it stands now, it is simply impossible to keep up with fraud in a paper-based system.  An electronic system would free tens of billions of dollars to be spent on investing the kind of modern system that will transform healthcare.
4. Implementing science and investment-based budgeting with generation-long scoring. The U.S. government must be able to distinguish cost from investment, and the 1974 Budget Act must be amended to reflect this.  Former NIH director Dr. Elias Zerhouni noted in recent testimony before the U.S. House and Senate that $10 billion invested in basic research on HIV/AIDS between 1985 and 1995 saved the United States $1.4 trillion in healthcare expenditures – a return on investment of 140 to one.  However, according to current scoring models, the $1.4 trillion saved would not be taken into account, as the $10 billion would be viewed purely as cost.  As it stands, the current budget mechanism is so inadequate and destructive that scoring models must be replaced.

• Send examples (including news articles or personal experiences) of instances of fraud in Medicaid or Medicare. Download a template here and submit to fraud@healthtransformation.net.
• Share examples of solutions and breakthroughs that have proven to create better health while also saving money by emailing us at bestpractices@healthtransformation.net.
• Post links to videos related to either of the first two items at www.youtube.com/healthtransformation
• Select providers who use electronic records.
• Talk to your elected officials and support candidates who are committed to creating an electronic health system that will increase patient safety and prevent fraud.