Issue: Health Care

Walorski Demands Answers After Indiana Prescriber Writes $1.1 Million in Opioid Prescriptions for 108 Medicare Patients

Walorski Demands Answers After Indiana Prescriber Writes $1.1 Million in Opioid Prescriptions for 108 Medicare Patients

Questions Top Medicare Fraud Prevention Official About Steps Being Taken to Prevent Fraud and Abuse in Part D

WASHINGTON – U.S. Rep. Jackie Walorski (R-Ind.) today questioned Medicare’s top fraud prevention official about how safeguards failed to prevent a doctor in Indiana from prescribing more than $1 million in opioids to 108 patients under Medicare’s prescription drug program.

At a hearing of the House Ways and Means Oversight Subcommittee, Walorski asked Jonathan Morse, Acting Director of the Center for Program Integrity in the Centers for Medicare and Medicaid Services (CMS), about a recent Department of Health and Human Services (HHS) Office of Inspector General report on questionable prescribing patterns under Medicare Part D that cited an Indiana prescriber who in 2016 “wrote an average of 24 opioid prescriptions each for 108 beneficiaries who received extreme amounts,” at a cost to taxpayers of $1.1 million.

“What processes does CMS have in place to flag and investigate suspicious prescribing practices like this, and what do you think needs to be done to improve the system?” Congresswoman Walorski asked. “Obviously the filters that you’re talking about didn’t catch this. … As a result of these egregious violations, what new things are going into play now?”

“Well, we’re actually very pleased that the CARA [Comprehensive Addiction and Recovery Act] legislation from about a year ago was passed, and CMS is working to implement the Medicare lock-in program,” Acting Director Morse said. “Lock-in is something that’s been used very effectively by both state Medicaid programs, as well as by private payers, to be able to lock in a single beneficiary and a single prescriber. So essentially it helps monitor that overutilization and it helps sort of prevent that abuse from happening.”

The HHS Inspector General report also found “one in three Medicare Part D beneficiaries received a prescription opioid” last year, including 500,000 beneficiaries who received large amounts.

Video of Walorski questioning Morse at the hearing is available here. The text of their exchange is below.

REP. WALORSKI: Thank you, Mr. Chairman. Mr. Morse, according to this report, and many of us are talking about reports today, this is the HHS report, Office of Inspector General, on Medicare Part D, and it’s on this issue of opioids that you touched on just at the end of your testimony, and I appreciate that.

What I think is interesting about this and draws a red flag for me is one of the things they talk about here is a prescriber in my home state of Indiana wrote an average of 24 opioid prescriptions each for 108 beneficiaries in a year, costing Medicare Part D $1.1 million just to that Indiana physician. And I guess, I am not a health person, professional, it draws a red flag to me.

And I guess my question is, and I know you were probably getting to this on your statement, but what processes does CMS have in place to flag and investigate these suspicious prescribing practices like this, and what do you think needs to be done to improve the system, because I’m guessing that you’re going to say that, here’s what we do, and you’re going to say, yeah we need to do more, so my question is, what is the more, and whatever the filters are, to have gone through, one doctor in my state to be able to produce these kinds of records, I think is astounding. So just from your professional opinion, where do we go on this, what else has to happen, and then what do we do as Congress to help you get those filters?

MR. MORSE: Thank you. And we’ve reviewed that opioid report from the Inspector General’s office also, and it is quite concerning. We’ve got a number of efforts underway, in Medicare, both fee-for-service and in Medicare Part D, that try to address opioid prescribing abuses, as well as it’s obviously been a major focal point of this administration, of the secretary, of the past administration. CMS already has an opioid strategy that it published in January of 2017 on this very issue, and looking at sort of all the various levers that an agency as a payer can potentially be sort of pulling to help to address the opioid epidemic.

From the program integrity side, we have a number of things that we look at. We work with the Medicare program on the Overutilization Monitoring System that looks at it largely from the beneficiary perspective but looks at, does the beneficiary potentially have too many prescriptions, are there too many potentially in this case opioid prescriptions being prescribed in overlapping ways and how do we kind of make sure that is not –

REP. WALORSKI: Right, but obviously the filters that you’re talking about didn’t catch this. And so, from your perspective, if you had the magic wand and you could say, look, I’m over this, I studied this, I’m the professional, here’s exactly what we need to do, let’s at least try this, what would it be? Because the other thing disturbing about this, there’s a half a million beneficiaries receiving high amounts of opioids. So the filters aren’t working, so whatever was done prior to January of 2017 is not working, so we take that off the chart here, and we say that you say what is it that we’re not seeing here, and what can you in Congress do to help you get there?

MR. MORSE: We also have abusive prescribing authorities within Program Integrity at CMS.

REP. WALORSKI: Do you use them often?

MR. MORSE: We have used them only a handful of times at this point, because part of it is we need to be able to establish sort of that pattern and the practice, and when we see a pattern and practice it often is then referred to law enforcement.

REP. WALORSKI: How long is a pattern and a practice? So my Hoosier doc here that took this to the limit and over the top, so he’s writing an average of 24 prescriptions each for 108 people in a year, and it wasn’t flagged.

MR. MORSE: But when we do see something like that in our data, we flag it for law enforcement, so that’s how those cases begin, though. So in that case, there may have been data from CMS, in this particular case, there may have been data from CMS that we then flag for our law enforcement partners who then begin those investigations. So when the behavior is that egregious, if it’s something that we can see in our data, it is something that we need to be able to send to the inspector general’s office, to the state law enforcement, to DOJ, and then they begin sort of the more serious criminal and civil processes.

REP. WALORSKI: So what happens now as a result of this report? Because still what you’re describing is what’s happening pre-2017. As a result of these egregious violations, what new things are going into play now?

MR. MORSE: Well we’re actually very pleased that the CARA legislation from about a year ago was passed, and CMS is working to implement the Medicare lock-in program. So lock-in is something that’s been used very effectively by both state Medicaid programs as well as by private payers to be able to lock in a single beneficiary and a single prescriber. So essentially it helps monitor that overutilization and it helps sort of prevent that abuse from happening.

REP. WALORSKI: I appreciate it. Thank you, Mr. Chairman.

Walorski represents the 2nd Congressional District of Indiana, serving as a member of the House Ways and Means Committee.

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Walorski Statement on Anthem and MDwise Exiting Indiana Obamacare Exchange

Walorski Statement on Anthem and MDwise Exiting Indiana Obamacare Exchange

“This is the latest sign of Obamacare’s failure to ensure Hoosiers have access to quality, affordable health care.”

WASHINGTON – U.S. Rep. Jackie Walorski (R-Ind.) today released the following statement after Anthem and MDwise announced they will withdraw from Indiana’s Obamacare marketplace in 2018:

“This is the latest sign of Obamacare’s failure to ensure Hoosiers have access to quality, affordable health care. Now even more Hoosiers, already facing higher costs and fewer options, will be forced to look for new plans and new doctors. Obamacare is collapsing, and I am committed to replacing it with a patient-centered system that lowers costs, increases choices, and provides real protections.”

BACKGROUND

Premiums for individual insurance plans in Indiana have risen 74 percent under Obamacare, according to a recent report from the Department of Health and Human Services. Four of the eight insurers on Indiana’s exchange withdrew this year, and premiums increased by an average of 18 percent for all but one of the remaining options.

Walorski voted for the American Health Care Act (H.R. 1628), which would repeal and replace Obamacare, protect patients with pre-existing conditions, ensure access to quality, affordable health care, and give states flexibility to implement innovative reforms. The legislation passed the House in May and is now under consideration in the Senate.

Walorski represents the 2nd Congressional District of Indiana, serving as a member of the House Ways and Means Committee.

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Walorski Votes to Repeal and Replace Obamacare

Walorski Votes to Repeal and Replace Obamacare

American Health Care Act Protects Patients with Pre-Existing Conditions, Begins Stable Transition to Better System

WASHINGTON – U.S. Rep. Jackie Walorski (R-Ind.) today released the following statement after the House passed the American Health Care Act, a bill to repeal Obamacare and replace it with a patient-centered system that protects patients with pre-existing conditions and returns control over health care to individuals and families:

“Too many Hoosiers are facing higher premiums, fewer options, and a collapsing system under Obamacare. That’s why I made a promise to the people of Indiana’s 2nd District to repeal Obamacare and replace it with a patient-centered system that lowers costs, provides real protections, and gives individuals and families control over their health care again.

“Today the House delivered on that promise to fix our nation’s health care system. The American Health Care Act protects patients with pre-existing conditions, ensures access to quality, affordable health care, and gives states the flexibility they need to enact innovative reforms like those in Indiana.

“This bill ends Obamacare’s burdensome taxes and mandates, including a permanent repeal of the job-killing medical device tax that harmed innovative manufacturers and their employees across Indiana. It protects life by stopping the flow of taxpayer dollars to abortion providers like Planned Parenthood. And with today’s passage of additional legislation I co-sponsored, it will treat Members of Congress the same as everyone else.

“I look forward to working with my Senate colleagues to get the American Health Care Act to President Trump’s desk for his signature so we can build a health care system that puts patients first.”

BACKGROUND

The House passed the American Health Care Act (H.R. 1628) by a vote of 217 to 213. The House also unanimously passed H.R. 2192, which ensures Members of Congress are treated the same as all other Americans under the AHCA.

Together these bills will:

  • Protect patients with pre-existing conditions and allow young adults to stay on their parents’ health care plan until age 26;
  • Provide families and small businesses relief from nearly $900 billion in burdensome taxes and mandate penalties;
  • Ensure Americans have access to quality, affordable health care through tax credits, expanded health savings accounts (HSAs), and a Patient and State Stability Fund;
  • Give states flexibility to implement innovative reforms and tailor solutions to the needs of their own citizens, instead of one-size-fits-all policies from Washington;
  • Require states seeking a waiver of certain insurance coverage requirements to implement a system to ensure coverage for older and sicker patients; and
  • Begin a stable transition period to ensure no one has the rug pulled out from under them.

Walorski represents the 2nd Congressional District of Indiana, serving as a member of the House Ways and Means Committee.

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Walorski Co-Sponsors Bill to Prevent Health Care Exemption for Members of Congress

Walorski Co-Sponsors Bill to Prevent Health Care Exemption for Members of Congress

WASHINGTON – U.S. Rep. Jackie Walorski (R-Ind.) today signed onto legislation that would ensure Members of Congress are not exempted from the American Health Care Act (AHCA).

“Members of Congress should not be treated differently from any other Americans,” Congresswoman Walorski said. “As we continue working to provide relief to individuals and families facing higher premiums, fewer options, and a collapsing system under Obamacare, this common-sense fix will ensure Congress lives by the same rules as everyone else.”

BACKGROUND

H.R. 2192, which was introduced earlier this week by Rep. Martha McSally (R-Ariz.), would repeal the exemption of Members of Congress and their staff from certain waivers if the American Health Care Act becomes law. The text of the bill is available here.

Walorski represents the 2nd Congressional District of Indiana, serving as a member of the House Ways and Means Committee.

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Walorski Meets with Families in Successful Program to Help Parents with Young Children

Walorski Meets with Families in Successful Program to Help Parents with Young Children

Healthy Families St. Joseph County Supported by Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program

SOUTH BEND, Ind. – U.S. Rep. Jackie Walorski (R-Ind.) today met with Hoosier families who have taken part in Healthy Families St. Joseph County, a voluntary home visiting program supported by the federal Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program. MIECHV is set to be reauthorized later this year and falls under the jurisdiction of the House Ways and Means Committee, of which Walorski is a member.

“Evidence-based programs like Healthy Families are helping Hoosier parents thrive and giving children the chance to achieve their full potential,” Congresswoman Walorski said. “I’m grateful for the opportunity to learn more about how this program serves our community and to hear directly from families who have benefited from it. I look forward to working with my colleagues to reauthorize the Maternal, Infant, and Early Childhood Home Visiting program that has shown so much promise in improving people’s lives.”

BACKGROUND

Healthy Families St. Joseph County is a program under the Family & Children’s Center, a community organization that serves more than 1,000 children and families each year. Congresswoman Walorski met with staff of Healthy Families St. Joseph County and the Family & Children’s, State of Indiana officials, and families who have benefited from participating in the program.

The Healthy Families program partners with the State of Indiana and the federal MIECHV program to provide expectant parents and parents of newborns with home visits by specialists who share tools and information to encourage healthy child development.

MIECHV is an evidence-based federal program that has shown positive outcomes in improving prenatal health, supporting childhood development, increasing financial independence, and preventing child abuse and neglect through voluntary home visiting services.

The Ways and Means Committee later this year will consider legislation to reauthorize the MIECHV program, which was first authorized in fiscal year 2010.

Walorski represents the 2nd Congressional District of Indiana, serving as a member of the House Ways and Means Committee.

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Walorski Statement on Health Care Legislation

Walorski Statement on Health Care Legislation

Spoke on House Floor in Support of Repealing, Replacing Obamacare

WASHINGTON – U.S. Rep. Jackie Walorski (R-Ind.) today released the following statement after the American Health Care Act was withdrawn from the House floor:

“Too many Hoosiers are facing higher premiums, fewer options, and a collapsing system under Obamacare. I’m disappointed in today’s outcome because the American people deserve relief from Obamacare’s broken promises.

“I remain committed to working with my colleagues and President Trump to build a patient-centered health care system that lowers costs, provides real protections, and returns control to individuals and families.”

Earlier today, Walorski spoke on the House floor in support of the legislation to repeal and replace Obamacare. Video of her remarks is available here.

Walorski represents the 2nd Congressional District of Indiana, serving as a member of the House Ways and Means Committee.

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Houses Passes Bipartisan Bills to Lower Health Insurance Costs

Houses Passes Bipartisan Bills to Lower Health Insurance Costs

Legislation Will Help Small Businesses Offer Employees Health Plans, Boost Competition in Insurance Marketplace

WASHINGTON – U.S. Rep. Jackie Walorski (R-Ind.) today voted for two bipartisan bills as part of efforts to repair the nation’s health care system.

“The bipartisan bills we passed today will help individuals and families access affordable health care by giving small businesses more leverage to negotiate health coverage for their employees and boosting competition in the insurance marketplace,” Congresswoman Walorski said. “In combination with the American Health Care Act, these bills will create a better health care system that lowers costs, increases choice, and puts patients first.”

BACKGROUND

The Small Business Health Fairness Act (H.R. 1101), which passed the House by a vote of 236 to 175, would allow small businesses to band together across state lines to offer their employees insurance through association health plans (AHPs). These AHPs would give small businesses more power to negotiate for lower health care costs, leveling the playing field with large businesses and unions.

The Competitive Health Insurance Reform Act (H.R. 372), which passed the House by a vote of 416 to 7, would eliminate antitrust exemptions for insurance providers. This would restore fair competition, protect consumers from consolidation in the insurance market, and lower health care costs.

Congress and the Trump administration are working to repeal Obamacare and repair our nation’s health care system through a three-phase process:

  • The first phase, the American Health Care Act, repeals Obamacare through budget reconciliation and begins a stable transition to a patient-centered system.
  • The second phase includes administrative actions by Health and Human Services Secretary Tom Price to stabilize insurance markets and bring down costs.
  • The third phase is the passage of additional legislation, beginning with today’s bills, to further improve access to affordable health care.

Walorski represents the 2nd Congressional District of Indiana, serving as a member of the House Ways and Means Committee.

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Walorski Statement on Improvements to the American Health Care Act

Walorski Statement on Improvements to the American Health Care Act

House Expected to Vote Thursday on Legislation to Repeal and Replace Obamacare

WASHINGTON – U.S. Rep. Jackie Walorski (R-Ind.) today released the following statement on an amendment to strengthen legislation to repeal Obamacare and begin a stable transition to a better health care system:

“With the American Health Care Act, we are delivering on our promise to the American people to repeal Obamacare and repair our nation’s health care system. These improvements will better help individuals and families access affordable health care and give states greater flexibility to implement innovative reforms like those in Indiana.

“President Trump met with House Republicans this morning and made clear he is with us 100 percent to deliver on our promise to the American people. I look forward to voting for this legislation and working with my colleagues in the Senate to get it to the president’s desk.”

BACKGROUND

The House on Thursday is expected to vote on the American Health Care Act (H.R. 1628), which repeals Obamacare and replaces it with a better health care system that lowers costs, increases choices, and protects patients. The legislation will:

  • Provide relief for families and small businesses from nearly $900 billion in burdensome taxes and mandate penalties;
  • Ensure Americans have access to quality, affordable health care through tax credits, expanded health savings accounts (HSAs), and a Patient and State Stability Fund;
  • Give states flexibility to implement innovative reforms and tailor solutions to the needs of their own citizens instead of one-size-fits-all policies from Washington;
  • Protect patients with pre-existing conditions and allow young adults to stay on their parents’ health care plan until age 26; and
  • Begin a stable transition period to ensure no one has the rug pulled out from under them.

The amendment announced Monday evening is the product of an open legislative process and discussions between House Republicans and the Trump administration. It includes improvements to the bill that will:

  • Ensure older Americans can access affordable health care by laying the groundwork for additional support for those aged 50 to 64;
  • Give states greater flexibility with Medicaid by adding the option of block grants instead of per capita allotments for traditional Medicaid populations and allowing work requirements for able-bodied adults without dependents;
  • Accelerate tax relief by dismantling Obamacare’s taxes and mandate penalties in 2017 instead of 2018;
  • Strengthen pro-life protections to prevent taxpayer dollars from being used to pay for abortions or abortion coverage; and
  • Unwind the Medicaid expansion responsibly by preventing new states from enrolling in the expansion while continuing to allow individuals who enroll through 2019 to stay in the program until they naturally cycle out.

Walorski represents the 2nd Congressional District of Indiana, serving as a member of the House Ways and Means Committee.

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Walorski Statement on CBO Analysis of the American Health Care Act

Walorski Statement on CBO Analysis of the American Health Care Act

MISHAWAKA, Ind. – U.S. Rep. Jackie Walorski (R-Ind.) today released the following statement after the Congressional Budget Office (CBO) released its report on the American Health Care Act, legislation to repeal Obamacare and begin a stable transition to a better health care system:

“Obamacare forced millions of Americans into one-size-fits-all plans they can’t afford, while our bill gives people the freedom to choose plans in a competitive market. It’s no surprise the CBO predicts fewer people will purchase health insurance once they are no longer forced to do so.

“The American Health Care Act – along with additional administrative and legislative measures – will lower costs, increase choices, stabilize markets, and protect patients. The CBO report confirms that the reforms in this bill will lower premiums in the long term, provide individuals and families with relief from Obamacare’s taxes and mandates, and save taxpayers more than $330 billion.

“I look forward to continuing to work with my colleagues in Congress, the Trump administration, and Governor Holcomb to take control away from Washington, give states the flexibility to enact innovative reforms like those in Indiana, and put health care decisions back in patients’ hands.”

BACKGROUND

The American Health Care Act will repeal Obamacare and replace it with a better health care system that lowers costs, increases choices, and protects patients. Specifically, the legislation will:

  • Provide relief for families and small businesses from Obamacare’s burdensome taxes and mandates;
  • Protect patients with pre-existing conditions and allow young adults to stay on their parents’ health care plan until age 26;
  • Ensure Americans have access to quality, affordable health care through tax credits and expanded health savings accounts (HSAs);
  • Give states flexibility to tailor solutions to the needs of their own citizens instead of top-down, one-size-fits-all policies from Washington; and
  • Begin a stable transition period to ensure no one has the rug pulled out from under them.

Individuals and families who do not have access to job-based coverage, Medicare, or Medicaid will be able to use advanceable, refundable tax credits to purchase the health insurance plan of their choice. The legislation would also help families save for medical expenses by raising contribution limits for HSAs and expanding how they can be used.

The House Ways and Means Committee, of which Walorski is a member, last week held a markup of the portions of the legislation that fall under the committee’s jurisdiction. Walorski voted to advance these portions, which include ending Obamacare’s taxes and mandates, enhancing HSAs, and providing tax credits for health coverage. The American Health Care Act will be considered this week by the House Budget Committee.

The full text of the American Health Care Act is available at readthebill.gop.

Walorski represents the 2nd Congressional District of Indiana, serving as a member of the House Ways and Means Committee.

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Walorski Votes to Advance Obamacare Repeal Legislation

Walorski Votes to Advance Obamacare Repeal Legislation

Ways and Means Committee Completes Markup of the American Health Care Act

WASHINGTON – U.S. Rep. Jackie Walorski (R-Ind.) today released the following statement after voting in the House Ways and Means Committee to advance portions of the American Health Care Act:

“We are one step closer to ensuring Americans have access to quality, affordable health care. The American Health Care Act will repeal Obamacare and replace it with a patient-centered system that puts individuals and families back in control of their health care decisions. By advancing the policies President Trump outlined last week, we are delivering on our promise to provide relief for the millions of Americans facing higher costs and fewer choices under Obamacare.”

BACKGROUND

The Ways and Means Committee, of which Walorski is a member, held a markup of those portions of the American Health Care Act that fall under the committee’s jurisdiction. The Ways and Means portions include:

  • Dismantling Obamacare’s burdensome taxes and mandates, including individual and employer mandate penalties and taxes on medical devices, prescription drugs, over-the-counter medications, and health insurance premiums;
  • Ensuring access to affordable, quality health care through tax credits for individuals and families who don’t receive insurance through their employer or a government program; and
  • Giving patients more control over their health care dollars by expanding and enhancing health savings accounts.

This legislation will be combined with the Energy and Commerce Committee’s legislation into one reconciliation package. The combined bill will repeal Obamacare and replace it with a better health care system that lowers costs, increases choices, and protects patients.

Specifically, the American Health Care Act will:

  • Provide relief for families and small businesses from Obamacare’s burdensome taxes and mandates;
  • Protect patients with pre-existing conditions and allow young adults to stay on their parents’ health care plan until age 26;
  • Ensure Americans have access to quality, affordable health care through tax credits and expanded health savings accounts (HSAs);
  • Give states flexibility to tailor solutions to the needs of their own citizens instead of top-down, one-size-fits-all policies from Washington; and
  • Begin a stable transition period to ensure no one has the rug pulled out from under them.

The full text of the American Health Care Act is available at readthebill.gop.

A summary of the legislation is available HERE.

A section-by-section of the Ways and Means portions of the legislation is available HERE.

Walorski represents the 2nd Congressional District of Indiana, serving as a member of the House Ways and Means Committee.

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