Grassley Questions Agency on Decision to Shut Down Public File on Disciplined Doctors

WASHINGTON - Sen. Chuck Grassley of Iowa today asked the head of a federal agency to explain a decision to shut down public access to data on malpractice payouts, hospital discipline and regulatory sanctions against doctors and other health professionals.  The public data file did not include doctors' names, only data that would allow journalists and analysts to track trends in disciplinary actions.  The Health Research and Services Administration shut down the public file after a newspaper reporter used the publicly available information to track down the identity of a doctor who had a long record of malpractice cases against him but was never disciplined by the state.

"Shutting down public access to the data bank undermines the critical mission of identifying inefficiencies within our health care system - particularly at the expense of Medicare and Medicaid beneficiaries," Grassley wrote in his letter to the agency.  "More transparency serves the public interest. Generally speaking, except in cases of national security, the public's business ought to be public.  Providers receive billions of dollars in state and federal tax dollars to serve Medicare and Medicaid beneficiaries. Accountability requires tracking how the money is spent."

The text of Grassley's letter is available here.   More information on how journalists have used the public database to inform the public is available here.

Prepared Statement of Ranking Member Chuck Grassley

Senate Committee on the Judiciary

Executive Business Meeting

Thursday, October 6, 2011

Mr. Chairman,

With regard to the judicial nominations, we are prepared to vote on the following nominations today:  Wallach, Christensen, Bencivengo, Groh, and Brodie.   We have a request on our side for a roll call vote on Wallach.  There are requests on our side to hold over the following nominees, who are appearing for the first time on our agenda:  Jordán, Gerrard, Phillips, Rice, Nuffer, Frank, Pane, and Webb.

We have a number of bills on the agenda today that appear for the first time.  We have a request on our side to hold over all of them for consideration next week.

On the legislation, I would like to say a few words about S.1301, the Trafficking Victims Protection Reauthorization Act.  We held a hearing on this legislation just three weeks ago that focused on the administration of programs designed to help victims of trafficking.

It is my hope that that the administration will get back to us with the questions we submitted for the record so we can consider those as part of our discussion on the bill next week.

I am pleased to report that my staff and the Chairman's have been working together for the last few weeks to find common ground on this issue.  However, there are changes needed in the draft to ensure that we recognize the changing times and the current fiscal crisis.  We need to ensure that our resources are carefully spent and are only provided to programs that are working.

At the hearing, I raised my concerns with the Department of Justice about a number of audits that have been conducted showing shocking examples of waste and abuse of grants.  I highlighted how the Inspector General had pulled nine specific grants and reviewed them for compliance.  All nine of those audits found hundreds of thousands of dollars in questioned costs, unauthorized expenditures, failed matching requirements, questioned salaries and fringe benefits, and many other problems.

I raised these audits with the witness from the Department of Justice, Office of Justice Programs who admitted that one audit that questioned over $1.3 million of a $1.7 million grant, showed that the grant was a failure.  This is unacceptable and the American taxpayers deserve better.  These audits demand our attention and that is why we "reauthorize" these programs?to make sure the money isn't being wasted.

Yet, here, we have audits showing that money is being wasted.  So we have the opportunity and responsibility to fix this.  Our efforts to reauthorize this legislation need to fix this problem and ensure that grantees that commit violations like this never see another federal dollar.  We need transparency, accountability, and performance from grantees that are trusted with federal dollars.  Absent any of these three things, they should not receive any money.

Further, we need to hold accountable the Justice Department, State Department, and other federal agencies that award trafficking grants under the TVPA.  These bureaucracies often turn a blind eye to the waste, abuse, and mismanagement of these grants, leading up to these audits.

Too often, the agencies simply fail to conduct the oversight required of the grants and then plead ignorant when the Inspector General finds problems.  This too has to stop.  Both the grant managers and the grantees should be held accountable.  It starts at the top with the head of the agency and we need those in power at these agencies to question spending, not just push taxpayer dollars out the door.

Unfortunately, as the recent report on conference expenditures at the Justice Department points out, it's clear this Justice Department doesn't understand that.  We all heard about the infamous $16 muffins and all the hay the hotels and the Justice Department have raised to refute the finding.  Well, what they can't hide from is the fact that since President Obama took office, conference spending at the Justice Department has nearly doubled from the Bush administration.

In fiscal 2008, the Justice Department spent $47.8 million on conferences.  In President Obama's first year, Fiscal Year 2009, that increased to $73.3 million.  Last year, it increased further to $91.5 million.  That is not fiscal responsibility, that's excess and waste.

The point is, we are well past the time when we can reauthorize programs without giving them the scrutiny needed.  We have a Justice Department that is addicted to spending without control and we need to rein that in.  We need to use this opportunity to ensure that hard earned taxpayer dollars are going to the people we are trying to help, here that's the victims of trafficking.  If we continue to allow grants to be mismanaged, a victim who could have been helped goes without.

I hope the Chairman and I can continue our work and reach an agreement on this bill for next week.  Thank you.

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Monday, October 3, 2011

More Conference Expenditures Placed Under Microscope

WASHINGTON - Senator Chuck Grassley has inquired about taxpayer dollars being spent on yet another conference, this time in Tokyo, as part of an "International Series" of conferences according to the Federal Circuit Court of Appeals website.  The intellectual property conference is being sponsored, in part, by the U.S. Patent and Trademark Office to the tune of $189,600.  The office is also sending several employees to the conference. In addition, the Federal Circuit Court of Appeals is apparently sending up to eight people to the international conference.

Grassley has previously looked at conference expenditures, most recently following a Justice Department Inspector General's office report outlining unacceptable amounts of spending.

"Between 2008 and 2010, spending on conferences at the Justice Department increased from $47.8 million to $91.5 million.  The Justice Department may or may not be the only bad egg in the bunch, but they helped shine a light on outrageous spending, just when we need to be tightening our belt.  A nearly $200,000 conference appears to be just why we need to put a microscope on conference expenses at agencies across the federal government," Grassley said.

Grassley sent letters to both the Department of Commerce and the Administrative Office of the U.S. Courts asking questions about the Tokyo conference and the "International Series."

Here are copies of the text of the letters.  Copies of the signed letters to the Department of Commerce and the Administrative Office of the U.S. Courts can be found here.

VIA ELECTRONIC TRANSMISSION

The Honorable Rebecca M. Blank

Acting Secretary

U.S. Department of Commerce
1401 Constitution Ave., NW
Washington, DC 20230

Dear Acting Secretary Blank:

I am writing because of information that I have received about spending related to an intellectual property conference in Tokyo, Japan, which is scheduled for late October 2011.  I am concerned about the amount of taxpayer dollars spent by Administrative agencies for conferences, seminars and travel, especially during this time of fiscal constraint.

The website for the Federal Circuit Court of Appeals (CAFC) states that the conference is part of an "International Series" of conferences that was developed in November 2010 to "look for the 'best practices in legal systems' worldwide and 'how those practices?both in terms of governance and the practice of law?relate to innovation and the betterment of societies.'" The website lists the Department of Commerce and the United States Patent & Trademark Office (USPTO) among those funding the conferences.  It is my understanding that the USPTO is spending approximately $189,600 to sponsor the Tokyo conference.

According to information I have received from a whistleblower, the USPTO will be sending at least four participants to the Tokyo conference, including its Director, Deputy Director and its Deputy General Counsel and the CAFC will be sending as many as eight participants including: the Chief Judge of the court, five other Circuit Judges, the Circuit Executive and Clerk of the court.

Consequently, I have a number of questions about the Tokyo conference, other conferences sponsored by USPTO and/or its affiliate, the Global Intellectual Property Academy (GIPA), and the amount of government funds being spent on travel by the USPTO.  Accordingly, please respond to the following requests for information:

1. Has the USPTO previously sponsored or is it committed to sponsor any of the conferences in the International Series?  If so, for each such conference, set forth the date(s), location, title and subject matter.  Also, for each such conference, set forth how much the USPTO paid or is planning to pay to be a sponsor.

2. Has the USPTO paid for any of its employees to attend any of the past conferences in the International Series?  If so, for each such conference, identify by name and title, the employee(s) who attended.  Also, for each such conference identify the date(s), location, title and subject matter.  Finally, for each such conference, set forth how much the USPTO paid for the employee(s) to attend, broken down by (a) conference fees, (b) travel expenses, (c) hotel expenses, (d) meals and (e) other expenses.

3. Is the USPTO planning to pay for any of its employees to attend the Tokyo conference?  If so, identify by name and title, the employee(s) who are scheduled to attend.  Also, set forth how much the USPTO is planning to spend in connection with its employees attending, broken down by: (a) conference fees, (b) travel expenses, (c) hotel expenses, (d) meals and (e) other expenses.

4. If you submit your responses after the Tokyo conference has taken place and employees attended, identify by name and title, the employee(s) who actually attended, if any.  Also, if applicable, set forth how much the USPTO actually paid for the employee(s) to attend, broken down by (a) conference fees, (b) travel expenses, (c) hotel expenses, (d) meals and (e) other expenses.

5. Other than the Tokyo conference, is the USPTO planning on paying to have any of its employees attend any of the other conferences in the International Series?  If so, for each such conference, identify by name and title, the employee(s) who are scheduled to attend.  If specific individuals are not yet scheduled to attend, for each conference set forth how many individuals the USPTO is planning on paying for.  Also, for each such conference identify the date(s), location, title and subject matter.  Finally, for each such conference, set forth how much the USPTO is planning to pay for its employee(s) to attend, broken down by (a) conference fees, (b) travel expenses, (c) hotel expenses, (d) meals and (e) other expenses.

6. During the last three years, has the USPTO sponsored any conferences or seminars?  If so, for each such conference or seminar, set forth the date(s), location, title and subject matter.  Also, for each such conference or seminar, set forth how much the USPTO paid to be a sponsor.

7. During the last three years, has the USPTO paid for any of its employees to attend a conference or seminar?  If so, for each such conference or seminar, set forth the date(s), location, title and subject matter.  And for each such conference/seminar, identify by name and title, the employee(s) who attended.  Also, for each conference or seminar, set forth how much the USPTO paid for the employee(s) to attend, broken down by (a) conference fees, (b) travel expenses, (c) hotel expenses, (d) meals and (e) other expenses.

8. During the next three years, is the USPTO planning to sponsor any conferences or seminars?  If so, for each such conference or seminar, set forth the date(s), location, title and subject matter.  Also, for each such conference or seminar, set forth how much the USPTO is planning to pay to be a sponsor.

9. During the next three years, is the USPTO planning to pay for any of its employees to attend a conference or seminar?  If so, for each such conference or seminar, set forth the date(s), location, title and subject matter.  Also, for each such conference or seminar, set forth how much the USPTO is planning to pay for its employee(s) to attend.  If possible break down those amounts by: (a) conference fees, (b) travel expenses, (c) hotel expenses, (d) meals and (e) other expenses.

10. Does the USPTO have a policy governing its sponsorship of conferences or seminars?  If so, and if that policy is in writing, provide a copy of the document.  If the USPTO has a policy but it is not in writing, set forth the policy and explain why it is not a written policy.

11. Does the USPTO have a policy governing its paying for its employees to attend conferences or seminars?  If so, and if that policy is in writing, provide a copy of the document.  If the USPTO has a policy but it is not in writing, set forth the policy and explain why it is not a written policy.

These are basic questions, the answers to which should be readily available. Please respond in writing by October 14, 2011.

Should you have any questions, please do not hesitate to contact Janet Drew or Tristan Leavitt of my staff at (202) 224-5225.

Thank you for your attention to this matter.

Sincerely,

Charles E. Grassley
Ranking Member

VIA ELECTRONIC TRANSMISSION

Jill Sayenga

Acting Director

Administrative Office of the United States Courts
One Columbus Circle, NE
Washington, D.C. 20544

Dear Acting Director Sayenga:

I am writing because of information that I have received about spending related to an intellectual property conference in Tokyo, Japan, which is scheduled for late October 2011.  I am concerned about the amount of taxpayer dollars the Federal Judiciary and the Administrative Office of the U.S. Courts spend on travel, especially during this time of fiscal constraint.

The website for the Federal Circuit Court of Appeals (CAFC) states that the conference is part of an "International Series" of conferences that was developed in November 2010 to "look for the 'best practices in legal systems' worldwide and 'how those practices?both in terms of governance and the practice of law?relate to innovation and the betterment of societies.'" The website lists the Department of Commerce and the United States Patent & Trademark Office (USPTO) among those funding the conferences.  It is my understanding that the USPTO is spending $189,600 to sponsor the Tokyo conference.

According to information I have received from a whistleblower, the USPTO will be sending at least four participants to the Tokyo conference, including its Director, Deputy Director and its Deputy General Counsel and the CAFC will be sending as many as eight participants including: the Chief Judge of the court, five other Circuit Judges, the Circuit Executive and Clerk of the court.

Consequently, I have a number of questions about the Tokyo conference, the other conferences in the International Series and the amount of government funds being spent on travel by the Federal Judiciary.  Accordingly, please respond to the following requests for information:

1. Has the CAFC previously sponsored or is it committed to sponsor any of the conferences in the International Series?  If so, for each such conference, set forth the date(s), location, title and subject matter.  Also, for each such conference, set forth how much the CAFC paid or is planning to pay to be a sponsor.

2. Has the CAFC paid for any of its judges or employees to attend any of the past conferences in the International Series?  If so, for each such conference, identify by name and title, the judge(s) and/or employee(s) who attended.  Also, for each such conference identify the date(s), location, title and subject matter.  Finally, for each such conference, set forth how much the CAFC paid for the judge(s) and/or employee(s) to attend, broken down by (a) conference fees, (b) travel expenses, (c) hotel expenses, (d) meals and (e) other expenses.

3. Is the CAFC planning to pay for any of its judges or employees to attend the Tokyo conference?  If so, identify by name and title, the judge(s) and/or employee(s) who are scheduled to attend.  Also, set forth how much the CAFC is planning to spend in connection with its judges and/or employees attending, broken down by: (a) conference fees, (b) travel expenses, (c) hotel expenses, (d) meals and (e) other expenses.

4. If you submit your responses after the Tokyo conference has taken place and CAFC judges or employees attended, identify by name and title, the judge(s) and/or employee(s) who actually attended, if any.  Also, if applicable, set forth how much the CAFC actually paid for the judge(s) and/or employee(s) to attend, broken down by (a) conference fees, (b) travel expenses, (c) hotel expenses, (d) meals and (e) other expenses.

5. Other than the Tokyo conference, is the CAFC planning on paying to have any of its judges or employees attend any of the other conferences in the International Series?  If so, for each such conference, identify by name and title, the judge(s) and/or employee(s) who are scheduled to attend.  If specific individuals are not yet scheduled to attend, for each conference set forth how many individuals the CAFC is planning on paying for.  Also, for each such conference identify the date(s), location, title and subject matter.  Finally, for each such conference, set forth how much the CAFC is planning to pay for its judge(s) and/or employee(s) to attend, broken down by (a) conference fees, (b) travel expenses, (c) hotel expenses, (d) meals and (e) other expenses.

6. During the last three years, has the Federal Judiciary (including the CAFC) sponsored any conferences or seminars?  If so, for each such conference or seminar, set forth the date(s), location, title and subject matter.  Also, for each such conference or seminar, set forth how much the Federal Judiciary paid to be a sponsor.

7. During the last three years, has the Federal Judiciary paid for any of its judge(s) and/or employees to attend a conference or seminar?  If so, for each such conference or seminar, set forth the date(s), location, title and subject matter.  And for each such conference/seminar, identify by name and title, the judge(s) and/or employee(s) who attended.  Also, for each conference or seminar, set forth how much the Federal Judiciary paid for the judge(s) and/or employee(s) to attend, broken down by (a) conference fees, (b) travel expenses, (c) hotel expenses, (d) meals and (e) other expenses.

8. During the next three years, is the Federal Judiciary planning to sponsor any conferences or seminars?  If so, for each such conference or seminar, set forth the date(s), location, title and subject matter.  Also, for each such conference or seminar, set forth how much the Federal Judiciary is planning to pay to be a sponsor.

9. During the next three years, is the Federal Judiciary planning to pay for any of its judge(s) and/or employees to attend a conference or seminar?  If so, for each such conference or seminar, set forth the date(s), location, title and subject matter.  Also, for each such conference or seminar, set forth how much the Federal Judiciary is planning to pay for its judge(s) or employee(s) to attend.  If possible break down those amounts by: (a) conference fees, (b) travel expenses, (c) hotel expenses, (d) meals and (e) other expenses.

10. Does the Federal Judiciary have a policy governing its sponsorship of conferences or seminars?  If so, and if that policy is in writing, provide a copy of the document.  If the Federal Judiciary has a policy but it is not in writing, set forth the policy and explain why it is not a written policy.

11. Does the Federal Judiciary have a policy governing its paying for its judges or employees to attend conferences or seminars?  If so, and if that policy is in writing, provide a copy of the document.  If the Federal Judiciary has a policy but it is not in writing, set forth the policy and explain why it is not a written policy.

Washington, DC - Senate Finance Committee Chairman Max Baucus (D-Mont.) and senior Finance Committee Member Chuck Grassley (R-Iowa) today released a Finance Committee staff report showing tactics used by major for-profit home health companies to game Medicare.  The result has been waste of taxpayer dollars and the delivery of what could be medically-unnecessary patient care to increase the companies' profits.  Baucus and Grassley initiated the investigation into the improper practices as part of the Committee's oversight role of the Medicare and Medicaid programs and the Senators' ongoing commitment to protect patients and taxpayer dollars from waste, fraud and abuse.

"The gaming of Medicare represents serious abuse of the home health program," said Baucus.  "Elderly patients in the Medicare system should not be used as pawns to increase a company's profits. Especially in these tough economic times, taxpayers simply cannot afford for their dollars to be wasted on unnecessary care.  We are going to continue to crack down on these companies to ensure taxpayer dollars are used efficiently and Medicare patients are protected."

"The reimbursement policy encourages gaming, and gaming is what's occurred.   Companies are doing everything they can to make as much money as possible, whether the patients need the care or not.  The federal government needs to fix the policy that lets Medicare money flow down the drain.  This can't wait until tomorrow.  It should have been done yesterday.  The longer this kind of policy continues, the more Medicare's budget balloons, and the bigger the burden on taxpayers," Grassley said.

In May 2010, Baucus and Grassley began their investigation into home health therapy practices at Amedisys, LHC Group, Gentiva, and Almost Family in response to a media report that these home health companies took advantage of the Medicare therapy payment system by providing medically-unnecessary patient care.

The Committee staff report released today examines documents provided by the companies which show how therapists were encouraged to target the most profitable number of therapy visits, even when patient need may not have required such visits.  In addition, therapy visit records for each company showed concentrated numbers of therapy visits at or just above the point at which a "bonus" payment was triggered by the Medicare program.

Internal documents from three of the four companies, Amedisys, LHC Group and Gentiva, provided evidence of top-down strategies to game Medicare.  Highlights from the report include :

• Managers encouraged therapists to meet a 10-visit target that would have increased their payments from Medicare.
• An "A-Team" tasked with developing programs to target the most profitable Medicare therapy treatment patterns.
• Therapists and regional managers that were pressured to follow new clinical guidelines developed to maximize Medicare reimbursements.
• Top managers instructed employees to increase the number of therapy visits provided in order to increase case mix and revenue.
• A competitive ranking system for management aimed at driving therapy visit patterns toward profitable levels.
• Evidence that management discussed increasing therapy visits and expanding specialty programs to increase revenue.

The Medicare Part A program pays out an estimated $19 billion yearly for home health care.  Fraud, waste and abuse in the health care system cost Americans an estimated $60 billion a year, approximately three percent of total health care spending.

Baucus and Grassley have led numerous major investigations of the health care industry to protect consumers and taxpayer dollars.  Earlier this year, when their investigation found that the drug company Sanofi interfered in the approval of generic alternatives to its blood-thinner drug Lovenox, the Finance leaders called on the Food and Drug Administration (FDA) to help guarantee consumers have access to affordable generic medications.  Last December, Baucus and Grassley released a report detailing the relationship between Abbott labs and a Maryland doctor who allegedly implanted nearly 600 unnecessary cardiac stents into his patients, costing the federal government as much as $3.8 million in overpayments.  The specific stent case highlighted in the Senators' report is indicative of a widespread, national problem of unnecessary stenting.  The Senators also spearheaded a two year inquiry which revealed undisclosed side effects of the diabetes drug Avandia.  This resulted in the FDA restricting use of the drug, ensuring that patients and doctors have the information they need to make safe, informed decisions about their medication.

The Committee's full report is available here.