Posts Tagged ‘health care fraud’
Thursday, March 10th, 2011

Saying that health care fraud is a significant law enforcement problem, a  Justice Department Criminal Division official on Wednesday urged Congress to stiffen penalties for swindlers and boost funding for investigations.

Greg Andres (photo by Christopher M. Matthews / Main Justice)

“Investment in health care fraud enforcement is a sound one, one that generates revenue,” Acting Deputy Assistant Attorney General Greg Andres of the Criminal Division told the Senate Homeland Security and Governmental Affairs federal financial management, government information, federal services and international security subcommittee. “And we believe that supporting our budget would be instrumental to us in continuing those efforts.”

In the hearing on Medicare and Medicaid fraud and waste, Andres called on Congress to back recommendations the U.S. Sentencing Commission made in January that would revise guidelines to increase sentences for health care swindlers. “These proposed amendments, if they become law,will subject health care fraud defendants to the possibility of even greater prison time than they already face, a prospect that we believe will be a more effective deterrent,” he said in his testimony.

Andres also asked Congress to support the request from the DOJ for extra funds in fiscal 2012 to combat health care fraud. Assistant Attorney General Tony West of the Civil Division  made a similar plea for increased funding when he testified at a Senate appropriations subcommittee hearing in February.

In its Fiscal year 2012 budget request released in February, the DOJ asks for $283.4 million to fight health care fraud,  a 22 percent increase from the funding Congress included in the current continuing resolution for Fiscal 2011. The extra money would allow Medicare Fraud Strike Force Enforcement Action Teams to expand to 20 locations, according to the DOJ. The teams of federal, state and local law enforcement officials, which were credited with the largest federal health care-fraud sweep in U.S. history, currently are located in nine cities.

The government has said it recovered $4 billion from individuals who tried to cheat Medicare and Medicaid in fiscal 2010. The collection was the largest amount ever recovered from Medicare and Medicaid swindlers in one year.

Senators agreed that more aggressive efforts to combat heath care fraud are needed. Sen. Scott Brown (R-Mass.) said defrauding Medicare and Medicaid isn’t “a victimless crime.”

“Waste, fraud and abuse undercuts the vitality of [entitlement] programs,” said Brown, the top Republican on the subcommittee. “The people that need it most aren’t getting the money. Just that alone, that’s just the tip of the iceberg.”

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Thursday, February 17th, 2011

Authorities have charged 111 defendants with Medicare fraud schemes in the largest federal health care-fraud sweep in U.S. history, Attorney General Eric Holder said Thursday.

Attorney General Eric Holder announces Medicare fraud takedown with Assistant Attorney General Lanny Breuer, Health and Human Services Secretary Kathleen Sebelius, FBI Executive Assistant Director Shawn Henry and HHS Inspector General Daniel Levinson.

Doctors, nurses and other members of the health care industry charged in nine cities on Thursday are accused of bilking the Medicare program out of more than $225 million, Holder said. He was joined by Health and Human Services Secretary Kathleen Sebelius, FBI Executive Assistant Director Shawn Henry, Assistant Attorney General Lanny Breuer of the Criminal Division and HHS Inspector General Daniel Levinson for the announcement at Justice Department headquarters.

The takedown Thursday netted 17 more defendants than the previous record-breaking sweep last summer. The defendants charged in July 2010 allegedly swindled the Medicare program out of $251 million.

“With today’s arrests, we’re sending an important message: health care fraud is not easy money,” Holder said. “It is a serious crime – and, as we’ve shown today, we will make sure it has serious consequences.”

Court documents unsealed Thursday offer a window into the shady, and sometimes deplorable, tactics used by the alleged fraudsters. They also shed light on the increasingly aggressive investigative techniques being employed by law enforcement officials.

Employees of Alliance Healthcare Services LP, a home health care provider in Dallas, are accused of offering kickbacks to Medicare beneficiaries to convince them to allow the company to bill Medicare under their names. The company allegedly billed over $1 million on behalf of Medicare beneficiaries from 2008 to 2010.

The sole job of one of the defendants, Ollie Futrell, was to recruit beneficiaries, the authorities said. The indictment charging Futrell and the four other conspirators contains conversations of Futrell’s negotiations covertly recorded by law enforcement agents:

Beneficiary: Each person I refer to you is $200 or $250?
Futrell: I’m going to be honest with you. I will give you $150. Alright $250,
$200. (Expletive) I ain’t goin fifty ’cause I got to have something now, come on.”

Officials said that in one of the more egregious examples of fraud, Dr. Boris Sachakov, a proctologist in Brooklyn, received $4.4 million from Medicare and $5.8 million from private benefit programs through false billings for examinations and surgical procedures. From 2008 to 2010, Sachakov billed millions for hemorrhoidectomies, or the removal of hemorrhoids,  he never actually performed.

The Attorney General credited the Medicare Fraud Strike Force Enforcement Action Teams with carrying out the takedown. The teams of federal, state and local law enforcement officials charged suspects Thursday in Miami, Los Angeles, Detroit, Houston, Tampa, Fla., Baton Rouge, La., and Brooklyn, N.Y.

The groups also brought charges in Chicago and Dallas. Holder announced Thursday that the cities were the newest locations for the teams.

Combating health care fraud is a top priority of President Barack Obama’s administration. The government has said it recovered $4 billion from individuals who tried to defraud Medicare and Medicaid in fiscal 2010. The recovery was the largest amount ever collected from Medicare and Medicaid fraudsters in one year.

In its fiscal year 2012 budget request, the DOJ requests $283.4 million to fight health care fraud, amounting to a 22 percent increase from the funding Congress approved through a continuing resolution for fiscal 2011.

Assistant Attorney General Tony West of the Civil Division was on Capitol Hill Tuesday to argue for a bigger budget to fight health care fraud in the coming years. He said current funding levels would limit DOJ efforts to combat the crime in the future.

The DOJ says it would use the extra funds in its fiscal 2012 request to beef up the Health Care Fraud Prevention and Enforcement Action Team, an initiative that brings together the Justice Department, Health and Human Services and other government agencies.

More money for HEAT would bring Medicare Fraud Strike Force Enforcement Action Teams to 20 locations, according to the DOJ.

Christopher M. Matthews contributed reporting.

Thursday, December 16th, 2010






Good morning.  It’s a pleasure to join with Secretary Sebelius – and with U.S. Attorney [Carmen] Ortiz, Deputy Administrator [Peter] Budetti, Inspector General [Dan] Levinson, and Assistant Attorney General [Tony] West – in welcoming you all here.  I want to thank Chancellor [J. Keith] Motley and the University of Massachusetts Boston for hosting us.  And I want to thank each of you for your participation in today’s discussion – and for your partnership in our national fight against health-care fraud.

We can all be encouraged by the number of people, and the diversity of perspectives, represented here.  I am glad to see that top federal and state officials; administration leaders; federal, state, and local law enforcement officers; health-care providers; as well as leading physicians, business executives, caregivers, investigators, and prosecutors have come together for this critical summit.

We share the same goals of protecting potential victims, safeguarding precious taxpayer dollars, and ensuring the strength of our health-care system.  Here in Boston – a city known for its world-class medical and nursing schools, its health research institutions, its 14 teaching hospitals, and its historic leadership in expanding access to healthcare – I know that many of you have concerns about the devastating effects of health-care fraud.  Despite the commitment you represent and the great work being done across Massachusetts and beyond – we can all agree that it’s time to take our nationwide fight against health-care fraud to the next level.

That’s what today is all about.  This summit is an important step forward – an opportunity to build on what has been discussed, and achieved, since January – when Secretary Sebelius and I convened the first “National Summit on Health Care Fraud” in Washington.  This past summer, we kicked off a series of regionally-focused conversations so that we could better understand, and more effectively address, the unique challenges being faced in different areas of the country.  So far, Secretary Sebelius and I have been to Miami, Los Angeles, and New York.  In the coming months, we plan to hold additional summits in Detroit, Philadelphia and Las Vegas.  Like Boston, many of these cities have become “hot spots” for health-care fraud schemes.  Here, and across New England, these crimes have reached crisis proportions, driving up health-care costs for everyone – and also hurting the long-term solvency of our essential Medicare and Medicaid programs.

But we are fighting back – in bold, innovative, and coordinated ways.

Last year brought an historic step forward in this fight – when the Departments of Justice and Health and Human Services launched the Health Care Fraud Prevention and Enforcement Action Team, known as “HEAT.”  Through HEAT, we’ve fostered unprecedented collaboration among our agencies and our law enforcement partners.  We’ve ensured that the fight against criminal and civil health-care fraud is a Cabinet-level priority.  And we’ve strengthened the work – and the record of success – of our Medicare Strike Forces.

This approach is working.

In fact, HEAT’s impact has been recognized by President Obama, whose FY-2011 budget request includes an additional $60 million to expand our network of Strike Forces to additional cities and to increase our civil False Claims Act enforcement.

With these new resources, and our continued commitment to collaboration, I have no doubt we’ll be able to extend HEAT’s record of achievement.  And this record – quite simply – is extraordinary.

In just the last fiscal year, we obtained settlements and judgments amounting to more than $2.5 billion in False Claims Act matters alleging health care fraud – the largest annual figure in history and an increase of more than 60% from fiscal year 2009.  We also opened more than 2,000 new criminal and civil health-care fraud investigations, reached an all-time high in the number of health-care fraud defendants charged, stopped numerous large-scale fraud schemes in their tracks, and returned more than $2.5 billion to the Medicare Trust Fund and more than $800 million to cash-strapped state Medicaid programs.

This work continues to grow.  Just yesterday, the Department announced settlements of more than $200 million with two pharmaceutical companies – Elan Corporation PLC, and its U.S. subsidiary Elan Pharmaceuticals Inc. – to resolve allegations of illegal and off-label marketing of an anti-seizure medication.  And we can all be encouraged, in particular, by what’s been accomplished in Massachusetts.

As Assistant Attorney General West highlighted earlier today, the U.S. Attorneys’ Office in this district played a leading role in reaching historic settlements – including the largest health-care fraud settlement in history.  Just last week, this district helped reach a settlement of more than $420 million with several pharmaceutical companies to resolve allegations of a scheme to report false and inflated prices – prices that federal healthcare programs rely on to set payment rates – for numerous pharmaceutical products.

In all, the District of Massachusetts has recovered, as [U.S. Attorney] Carmen [Ortiz] noted this morning, more than $4 billion in civil and criminal health-care fraud settlements over the past two years.  That’s right – $4 billion.  You should all be proud of these health-care-fraud enforcement efforts.  I certainly am.

As figures like these demonstrate, health-care fraud schemes across this region are being aggressively and permanently shut down.  This is the result of the hard work of many of the attorneys and investigators in this room.  And, in particular, I want to note the great work being done by Boston’s “Special Focus Team,” which attacks large-scale, corporate health-care fraud – from pharmaceutical fraud to medical-device company fraud – head on.  These efforts are providing proof that we can make measurable, meaningful progress in the fight against health-care fraud.

But we cannot do it alone.

We need your help.  We need your insights.  And we will rely on your recommendations to help guide and enhance HEAT’s critical work.

Despite all that’s been accomplished since HEAT was launched, health-care fraud remains a significant problem.  At this very moment, for example, we know that an alarming number of scam artists and criminals are attempting to profit from misinformation about the Affordable Care Act, which Congress passed – and President Obama signed into law – earlier this year.

Fortunately, this landmark legislation provides new resources and includes tough new rules and penalties to help stop and prevent health-care fraud.  And the Justice Department will continue to work vigorously with our law enforcement and private sector partners to ensure that those who engage in fraud cannot use this new law to steal from taxpayers, patients, seniors, and other vulnerable Americans.  We will keep industry leaders informed about emerging fraud schemes and help institute effective compliance and anti-fraud programs.  And we will punish offenders to the fullest extent of the law.  That’s a promise.

As Secretary Sebelius and I do our part in Washington to build on the progress that’s been made in combating health-care fraud, we want to work closely with you – and with state and local officials, officers, leaders, and advocates across the country.  Our continued success depends on the commitment we make, the priorities we establish, and the partnerships we forge now.  And your presence here today gives me great hope about what we can accomplish together going forward.

Thank you all, once again, for joining us and for your ongoing commitment to protecting the American people and ensuring the strength and integrity of our health-care system.  I look forward to working with you all.

Thank you.


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Thursday, December 16th, 2010
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Friday, July 2nd, 2010

Eastern District of Virginia U.S. Attorney Neil MacBride named four prosecutors to coordinator posts in his district, his office announced Friday.

They are:

  • Assistant U.S. Attorney Gerard Mene
  • New post: Affirmative Civil Enforcement coordinator
  • Old post: Health care civil fraud coordinator
  • Assistant U.S. Attorney Marla Tusk
  • New post: Health care fraud coordinator in Alexandria, Va.
  • Old post: Narcotics and financial fraud prosecutor
  • Assistant U.S. Attorney Jessica Aber Brumberg
  • New post: Health care fraud coordinator in Richmond, Va.
  • Old post: Prosecutor working on fraud, firearms, narcotics and child exploitation cases
  • Assistant U.S. Attorney Katherine Lee Martin
  • New post: Health care fraud coordinator in Norfolk, Va., and Newport News, Va.
  • Old post: Fraud prosecutor

Read more about the Affirmative Civil Enforcement coordinator here and the health care fraud coordinators here.

Please send news of moves, promotions and honors to

Thursday, April 1st, 2010

Hank Bond Walther. (photo by Christopher M. Matthews / Main Justice)

Hank Walther has been promoted to Acting Deputy Chief for health care fraud in the Justice Department Criminal Division’s Fraud Section.

According to former DOJ officials, the Fraud Section also is in the process of hiring new prosecutors in an effort to continue the department’s heightened efforts to tamp down on health care fraud. One former official said the department could bring in more than 20 new prosecutors to the health care fraud team, a move that would double the team’s size.

DOJ spokeswoman Laura Sweeney said she could not comment on the specifics, but that the department was committed to increasing the resources dedicated to this area.

Walther is replacing Kirk Ogrosky, who left the department earlier this month to become a partner at Arnold & Porter LLP. During Ogrosky’s tenure, health care fraud became a priority in the Fraud Section. When Ogrosky left, the health care team was already the largest in the Fraud Section, in terms of number of prosecutors.

Ogrosky created and implemented the Medicare Fraud Strike Force teams currently used in Miami, Baton Rouge, Brooklyn, Los Angeles, Detroit and Houston. Based on those teams’ success, the Justice Department is planning to expand the use of the strike forces.

Walther was hired in January 2006 as a trial attorney in the Fraud Section, working on everything from securities fraud to health care fraud. He became an Assistant Chief for the Foreign Corrupt Practices Act team in October 2008, and he is currently the lead prosecutor in the FCPA “sting” case.

During a telephone interview, Ogrosky said he thought highly of his replacement.

“He’s an outstanding pick. He not only understands the program and what I was trying to do, but he also has the experience of being a prosecutor, actually trying these cases,” Ogrosky said.

Walther was involved with the first strike force team in Miami. Ogrosky said that his time spent dealing with FBI agents and prosecuting cases would serve him well.

“You’ve got to get out there in these cities,” he said. “These criminals are not static — they don’t sit around waiting in Washington for people to do things, they change.”

Sweeney said that Walther’s promotion had been announced to the section on March 4.

The DOJ’s increased efforts in the health care fraud area coincide with the Obama administration’s declarations that fighting health care fraud is a priority. Against the backdrop of the enactment of massive health care legislation, the administration has asked for $90 million in fiscal 2011 — an increase of $60 million — to combat health care fruad.

During a hearing before a House Appropriations subcommittee earlier this month, acting Deputy Attorney General Gary Grindler said that more than half of that amount would cover costs of deploying health care strike forces in as many as 13 new cities.

The Criminal Division and the U.S. Attorneys’ offices collaborate in the task forces, but Grindler said the department expected the latter to “continue these programs in perpetuity” once staffed with trained agents and Assistant U.S. Attorneys. Grindler said the strike forces in Miami and Los Angeles had become fixtures in their respective U.S. Attorneys’ offices.

Friday, March 19th, 2010

The House Democrats’ newest health care proposal includes a $250 million boost in funding over the next decade to combat health care fraud, waste and abuse.

On Thursday, the House Rules Committee posted the final text of the Democrats’ health care proposal. The 2310-page bill calls for a number of anti-fraud measures including increased oversight of payments made by government health care programs and harsher penalties for providers and suppliers who attempt to defraud the programs.

Among the oversight provisions are increase use of so-called bounty hunters to retrieve money spent on improper and fraudulent payments. President Barack Obama has discussed such efforts at recent rallies.

Democrats say that reining in waste, fraud and abuse will help reduce the deficit by $138 billion over the next ten years, and an additional $1.2 trillion during the following decade, according to the Congressional Budget Office.

“[It's] a tiny step in the right direction,” Jim Frogue of the Center for Health Transformation said. “There are more radical steps they could have taken…They could have done a lot more.”

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Monday, March 15th, 2010

During a Monday speech in Ohio, President Barack Obama vowed to go after health care fraud in government programs. The speech was Obama’s third in a week discussing the health insurance overhaul currently before Congress. Last week during a trip to  St. Charles, Mo., Obama discussed efforts to use so-called bounty hunters to retrieve money spent on improper and fraudulent payments.

In Monday’s Ohio speech, Obama said, “By now, we have incorporated most of the serious ideas from across the political spectrum about how to contain the rising cost of health care – ideas that go after the waste and abuse in our system, especially in programs like Medicare.”

The president cited Congressional Budget Office data that such efforts would decrease health insurance premiums and help reduce the deficit by up to $1 trillion over the next 20 years. “Yes, we are going after the waste, fraud, and abuse in Medicare.  But that’s because these are dollars that should be spent on care for seniors, not the care and feeding of insurance companies through subsidies and sweetheart deals,” Obama said.

The full text of the president’s speech:

Hello, Ohio!  It’s great to be here in the Buckeye State.  And it’s even better to be out of Washington for a little while.

I want to thank Connie and her family for being here on behalf of Natoma.  It’s not easy to share such a personal story.  I appreciate your willingness to do so.  I want you to know that she is the reason that I am here today.  I know that she felt it was important that her story be told.

Last month, I read a letter from Natoma.  She’s self-employed, trying to make ends meet, and has for years done the responsible thing: buying health insurance through the individual market.

The thing is, sixteen years ago, she was diagnosed with a form of treatable cancer.  And even though she had been cancer free for more than a decade, the insurance company kept jacking up her rates anyway, year after year.  So she increased her out-of-pocket expenses.  She raised her deductible.  She was doing everything she could to maintain health insurance that would be there for her in case she got sick.

But even as she upped her deductible to the maximum, last year Natoma’s insurance company raised her premiums by more than 25 percent.  Over the past year, she paid more than $6,000 in monthly premiums.  She paid more than $4,000 out-of-pocket for co-pays, medical care, and prescriptions.  So she ponied up more than $10,000 dollars.  But because she never hit her deductible, her insurer only spent $900 on her care.  And yet what comes in the mail at the end of last year?  A letter telling Natoma that her premiums would go up again by more than 40 percent.

She just could not afford it.  She didn’t have the money.  And despite her desire to keep her coverage – despite her fears that she would get sick and lose the home her parents built – she finally surrendered and gave up her health insurance.  January was her last month of being insured.  Like so many responsible Americans – folks who work hard every day, who try to do the right thing – she was forced to hang her fortunes on chance.  She hoped against hope she would stay healthy.  She feared terribly she would not.

That was the letter.  And I understand Natoma was pretty surprised when she found out that I read it – word for word – to the CEOs of America’s largest insurance companies – including the company that hiked up her rates by more than 40 percent.

This was less than two weeks ago.  But then Natoma’s worst fears were realized.  Just last week, she was working on a nearby farm, walking outside – apparently, chasing after a cow – when she collapsed.  She was rushed to the hospital.  She was very sick.  She needed two blood transfusions.  Doctors performed a battery of tests.  And on Saturday, Natoma was diagnosed with leukemia – a serious form of cancer.

The reason Natoma is not here today is that she’s lying in a hospital bed, suddenly faced with this emergency – suddenly thrust into a fight for her life.  She expects to face a month or more of aggressive chemotherapy.  And she is racked with worry not only about her illness but about the cost of the tests and treatments she will surely need to beat it.

I’m here because of Natoma.

I’m here because of countless others who have been forced to face the hardest and most terrifying challenges in their lives with the added burden of medical bills they cannot pay.

I’m here because I remember my own mother, in the last six months of her life, on the phone in her hospital room arguing with insurance companies when she should have been spending time with her family.

I’m here because of the millions denied coverage because of pre-existing conditions – or dropped from coverage when they get sick.

I’m here because of the small businesses forced to choose between health care and hiring.

I’m here because of the seniors unable to afford the prescriptions they need.

I’m here because of the folks seeing premiums going up by thirty, forty, fifty percent in a year.

I am here because this is not the America I believe in – and it’s not the America you believe in.

And so when you hear people say “start over” – I want you to think of Natoma.  When you hear people saying that this isn’t the “right time” – think of what she’s going through.  When you hear people talk about who’s up and who’s down in the polls – instead of what’s right or what’s wrong for the country – think of her and the millions of responsible people – working people – being hurt by today’s system of health insurance.  And I want you to remember: There but for the grace of God go I.

This status quo on health care is simply unsustainable.  We cannot have a system that works better for the insurance companies than it does for the American people.  We know what will happen if we fail to act.  We know our government will be plunged deeper into debt.  We know millions more people will lose coverage.  And we know that rising costs will saddle millions more families with unaffordable expenses – and will force many small businesses to drop coverage altogether.  A study just came out yesterday – a non-partisan study – which found that without reform, premiums could more than double for individuals and families over the next decade.  Family policies could pass $25,000.  Can you afford that?

We have debated health care in Washington for more than a year.  Every proposal has been put on the table.  Every argument has been made.  I know many people view this as a partisan issue, but both parties have found plenty of areas where we agree.  And what we’ve ended up with is a proposal that’s somewhere in the middle – one that incorporates the best ideas from Democrats and Republicans.

On one side of the spectrum, there were those who wanted to scrap our system of private insurance and replace it with government-run health care.  But I didn’t think that was practical or realistic.

On the other side of the spectrum, there are those who believe the answer is to simply unleash the insurance industry, by providing less oversight and fewer rules.  I call this the “putting the foxes in charge of the hen house” approach.  It would only give insurance companies more leeway to raise premiums and deny care.

I don’t believe we should give the government or the insurance companies more control over health care in America.  I believe it’s time to give you – the American people – more control over your own health insurance.

That’s why my proposal builds on the current system where most Americans get their health insurance from their employer.  If you like your plan, you can keep your plan.  If you like your doctor, you can keep your doctor.  I wouldn’t want any plan that interferes with the relationship between a family and their doctor.

Essentially, my proposal would change three things about the current health care system.  First, it would end the worst practices of insurance companies.  Within the first year of signing health care reform, thousands of uninsured Americans with pre-existing conditions will be able to purchase health insurance for the first time in their lives.  This year, insurance companies will be banned forever from denying coverage to children with pre-existing conditions.  This year, they will be banned from dropping your coverage when you get sick.  Those practices will end.

If this reform becomes law, all new insurance plans will be required to offer free preventive care to their customers starting this year – free check-ups so we can start catching preventable illnesses on the front end.  Starting this year, if you buy a new plan, there will be no more lifetime or restrictive annual limits on the amount of care you receive from your insurance companies.  And if you’re an uninsured young adult, you’ll be able to stay on your parents’ policy until you’re 26 years old.

The second thing that would change about the current system is this: for the first time, uninsured individuals and small businesses will have the same kind of choice of private health insurance that Members of Congress get for themselves.  If this reform becomes law, Members of Congress will be getting their insurance from the same place the uninsured get theirs.  Because if it’s good enough for the American people, it ought to be good enough for the people you send to Washington.

My proposal also says that if you still can’t afford the insurance in this new marketplace, we will offer you tax credits to do so – tax credits that add up to the largest middle class tax cut for health care in history.  After all, the wealthiest among us can already buy the best insurance there is, and the least well-off are able to get coverage through Medicaid.  But it’s the middle-class that gets squeezed, and that’s who we have to help.

Now, it’s true that all of this will cost money – about $100 billion per year.  But most of this comes from the nearly $2.5 trillion a year that America already spends on health care.  It’s just that right now, a lot of that money is being spent badly.  With this plan, we’re going to make sure the dollars we spend go toward making insurance more affordable and more secure.  We’re also going to eliminate wasteful taxpayer subsidies that currently go to insurance companies.  And we will set a new fee on insurance companies that stand to gain as millions of Americans are able to buy insurance.  Here’s the point: our proposal is paid for.

Finally, my proposal would bring down the cost of health care for families, businesses, and the federal government.  Americans buying comparable coverage to what they have today in the individual market would see premiums fall by 14 to 20 percent.  For Americans who get their insurance through the workplace, costs could fall by as much as $3,000 a person.

By now, we have incorporated most of the serious ideas from across the political spectrum about how to contain the rising cost of health care – ideas that go after the waste and abuse in our system, especially in programs like Medicare.  Our cost-cutting measures would reduce most people’s premiums and bring down our deficit by up to $1 trillion over the next two decades.  And those aren’t my numbers; they are the savings determined by the Congressional Budget Office, the nonpartisan, independent referee of Congress.

Now, the opponents of reform have tried a lot of different arguments to stop these changes.  But maybe the most insidious is the idea that somehow this would hurt Medicare.  And I know we’ve got some seniors with us today.  So let me just tell you directly: this proposal adds almost a decade of solvency to Medicare.  This proposal would close that gap in prescription drug coverage – called the doughnut hole – that sticks seniors with thousands of dollars in drug costs.  This proposal will over time help to reduce the costs of Medicare that you pay every month.  And this proposal would make preventive care free so you don’t have to pay out-of-pocket for tests that keep you healthy.

Yes, we are going after the waste, fraud, and abuse in Medicare.  But that’s because these are dollars that should be spent on care for seniors, not the care and feeding of insurance companies through subsidies and sweetheart deals.  Every senior should know: there is no cutting of your guaranteed Medicare benefits.  Period.  This proposal makes Medicare stronger, makes the coverage better, and makes its finances more secure.  Anyone who says otherwise is misinformed – or is trying to misinform you.

So that’s the proposal.  And I believe Congress owes the American people a final up-or-down vote.  Of course, now that we’re approaching this vote, we’re hearing a lot of people in Washington talking about the politics.  Talking about what this means for November.  Talking about the poll numbers for the Democrats and the Republicans.  But that’s why I wanted to come here today.

Because in the end, this debate is about far more than the politics.  It’s about what kind of country we want to be.  It’s about the millions of lives that would be touched and, in some cases, saved by making private health insurance more secure and more affordable.  It’s about a woman, lying in a hospital bed, who wants nothing more than to be able to pay for the care she needs.

And the truth is, what is at stake in this debate is not just our ability to solve this problem, but our ability to solve any problem.  The American people want to know if it’s still possible for Washington to look out for their interests and their future.  They are waiting for us to act.  They are waiting for us to lead.  And as long as I hold this office, I intend to provide that leadership.  I don’t know about the politics.  But I know what’s right.  So I am calling on Congress to pass these reforms – and I look forward to signing them into law.

Thank you, God bless you, and God bless the United States of America.

Monday, March 15th, 2010

Kirk Ogrosky (Arnold & Porter LLP)

Kirk Ogrosky, the Justice Department’s top health care fraud prosecutor, will become a partner in the white collar criminal defense and FDA/health care practices division of  Arnold & Porter LLP.

The firm announced the hire in a news release Monday.

Ogrosky has been Deputy Chief of the Fraud Section in charge of criminal health care matters at DOJ since 2006. In addition to handling prosecutions related to pharmaceutical and medical device manufacturers, hospitals and home health agencies, Ogrosky created and has managed the Medicare Fraud Strike Force. He also served on the Operations, Data, and Pharmaceutical enforcement committees of the Health care Fraud Prevention and Enforcement Action Team.

Before working at DOJ headquarters, Ogrosky served as an Assistant U.S. Attorney in Miami from 1999 to 2004, and as an assistant attorney general in Kentucky from 1996 to 1998.

“Kirk has an extraordinary record as a leader and a trial lawyer,” Daniel Kracov, head of the Arnold & Porter’s FDA and health care group, said in the release,. “His experience will further expand the firm’s capabilities in high-stakes health  care fraud and abuse and Foreign Corrupt Practices Act matters.”

In an interview with The Blog of Legal Times, Ogrosky said he is looking forward to working with Kracov. “There’s never been a better time to be a health care fraud lawyer,” Ogrosky said.

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Wednesday, March 10th, 2010

During a Wednesday rally in St. Charles, Mo., President Barack Obama criticized waste, inefficiency and fraud in Medicare and Medicaid as he sought public support for his health care plan. Such improper payments by the government programs account for more than is spent on the Education Department and the Small Business Administration combined, Obama said.

Full speech text:

THE PRESIDENT: Hello, Missouri!  (Applause.)  It is good to see you.  I know you guys have been a little bit here; it’s a little bit warm in here — you’re all fanning yourself off, whoo!  It is good to see everybody here today.  How’s everybody doing?  (Applause.)

I’ve got a couple of acknowledgments I want to make.  First of all, Mayor of St. Charles, Patti York — where’s Patti?  (Applause.)  Thank you, Madam Mayor.  Thanks for the great weather.

We also have the St. Charles School District Superintendent, Randy Charles, is here.  Where’s Randy?  I just saw him — there he is back there.  (Applause.)

It is great to be here, great to be back in the Show Me State, great to be back in St. Charles.  Some of you may remember that it was from this town that Lewis and Clark began their journey into a harsh and unforgiving landscape.  I can relate — (laughter) — because the first time I came here, I was trying to get to Washington, D.C., a harsh and unforgiving landscape.  (Laughter.)

A big part of our campaign was about changing the way Washington works.  It was about transforming a politics that’s driven by cynicism and a 24-hour news cycle, and the cable chatter, and always focused on the next election instead of the next generation.  Our campaign was about meeting the looming challenges — in education and in energy, in our health care system, in our financial system — that helped bring about the worst economic crisis since the Great Depression.  And it still threatens our prosperity.  It was about making our government actually work for you, the people:  a government that lives up to its responsibilities, including the responsibility to live within its means.

Now, there’s been a lot of discussion about government over the last several months — and let’s face it, people have lost faith in government.  They had lost faith in government before I ran and it’s been getting worse.  You know, President Lincoln said that “the legitimate object of government is to do for the people what needs to be done, but which they can not … do at all, or do so well, by themselves.”  That pretty much sums up my attitude.  You let people do for themselves what they can do for themselves; and then if there are some things that we do better together, we should do them together.  And I believe that in everything government does, we’ve got a special responsibility to be wise stewards about how Americans’ hard-earned tax dollars are spent.  And I know you agree with that, too.  Doesn’t matter whether you’re a Democrat or a Republican, you don’t like seeing your money wasted — or an independent, don’t like seeing your money wasted.

That’s a responsibility my administration is seeking to fulfill every single day.  Over the last year, we’ve gone through the budget line by line looking for places to trim the fat out of government.  And we’ve found a lot of fat to trim. I got to admit.  Last year, we pushed Congress to cut nearly $20 billion by streamlining or eliminating more than 120 government programs.  This year, we put another $20 billion in cuts on the table, targeting dozens of additional programs that were wasteful or duplicative or in some cases just plain ridiculous.

For example, we decided not to fund an office maintained by the Department of Education — in Paris, France.  (Laughter.)  Now, I’m sure that was nice work if you could get it.  (Laughter.)  But I didn’t think that was a real good use of our money.  We eliminated a decades-old radio navigation system which cost $35 million a year.  And some people might say, well, why did you do that?  We need that navigation system.  Well, the thing is, we got this thing call GPS now, and satellites.  (Laughter.)  So the whole radio navigation thing wasn’t working so well.

So we’ve been pushing for cuts on things that we don’t need, that government doesn’t do so well.  And we’re also reforming the way government contracts are awarded.  Think about this, between 2002 and 2008, the amount spent annually on government contracts more than doubled to half a trillion dollars.  Those are contracts with private contractors.  And the amount spent on no-bid contracts jumped by 129 percent — no-bid contracts.  That’s an inexcusable waste of your money.  So last March, I ordered federal departments to come up with plans to save as much as $40 billion a year in contracting.

Now, this brings me to the person standing right over here, the lady in pink.  (Applause.)  You know before Claire was your senator, she was your state auditor.  She just pinches pennies.  I mean, she’s just — (laughter) — you think I’m — I don’t like waste, but Claire, she just — every dime, she’s — (laughter.)

So thanks to Claire, we’re going to have a new tool to help us meet this goal of eliminating some of these wasteful contracts and no-bid contracts.  In the coming weeks we’re going to be rolling out a new online database, which Claire McCaskill proposed and helped pass into law.  (Applause.)  And we’ll be able to see, before any new contract is awarded, whether a company plays by the rules, how well they’ve performed in the past:  Did they finish the job on time?  Did the company provide good value?  Did the company blow their budget?  It’s your money, so you deserve to know how it’s spent and who these contracts are going to.

And that’s an example of the kind of service that Claire McCaskill is providing, not just to the people of Missouri, but people all across the country.  And in every way but one, Claire McCaskill is the new Harry Truman — (laughter) — in the United States Senate.  (Applause.)  The one difference is she’s a she.  (Laughter.)

But just as the Truman Commission prevented billions of dollars of wasteful spending during the war and saved lives in the process, through tough and fair-minded oversight of contracting during World War II, Claire has been a relentless force for rooting out scams and making government more efficient.  Harry Truman also said in the commission’s final report that in completing the mission, “[w]here necessary, heads must be knocked together.”  And let me tell you, Claire loves knocking some heads together.  (Laughter.)  She’s never been afraid to do that.  (Applause.)

As we were driving in, I was saying, boy, it’s just good to be back in the Midwest, this is about as close as I’ve been to home in a while.  And part of the reason it’s just good to be back is because Washington is a place where tax dollars are often treated like Monopoly money — they’re bartered and traded, and they’re divvied up among lobbyists and special interests, and where waste — even billions of dollars of waste — is accepted as the price of doing business.  When we proposed, by the way, those $20 billion in cuts last year, we were ridiculed by the press, said, “Ah, that’s just a spit in the bucket.”  Now, I don’t know about here in St. Charles, $20 billion, that’s real money, isn’t it?


THE PRESIDENT:  That’s real money.  But Claire doesn’t accept business as usual.  I don’t accept business as usual.  You don’t accept business as usual.  The American people don’t accept business as usual, especially when we’re facing these enormous long-term deficits that threaten to leave our children a mountain of debt.

Now, this brings me to the primary topic I want to talk about today.  Nowhere is reform more needed than when it comes to our health care system — nowhere.  (Applause.)  Nowhere.  (Applause.)  The health care system has billions of dollars that should go to patient care and they’re lost each and every year to fraud, to abuse, to massive subsidies that line the pockets of the insurance industry.

Let me just give you one example — this is a long recognized but long tolerated problem called “improper payments.”  That’s what they call them.  Washington always has a name for these things.  “Improper payments.”  And as is often the case in Washington, the more innocuous the name, the more worried you should be.  So these are payments mostly made through Medicare and Medicaid that are sent to the wrong person, sent for the wrong reason, sent in the wrong amount.  Sometimes they’re innocent errors.  Sometimes they’re because nobody is bothering to check to see where the money is going and they’re abused by scam artists and fly-by-night operations.

(The President coughs.)  Look, health care.  (Laughter.)  This health care debate has been hard on my health, I got to tell you.  (Laughter.)

It’s estimated that improper payments cost taxpayers almost $100 billion last year alone.  Think about that.  That, by the way, just that abuse in improper payments is more than we spend on the Department of Education and the Small Business Administration combined.  If we created a “Department of Improper Payments” it would be one of the largest agencies in our government.

Now, for the past few years, there has actually been a pilot program that uses a system of tough audits to recover some of this lost money.  And even though these audits, they were just operating mainly in three states, they already found a billion dollars in improper payments.  So these results were both disturbing and encouraging.  They’re disturbing because it shows you how much waste there is out there in the health care system.  But it’s encouraging because we can do something about it.

So earlier today, with Claire looking over my shoulder — one of our auditors-in-chief — I signed an order calling on all federal agencies to launch these kinds of audits all across the country.  All across the country.  (Applause.)  So agencies would hire auditors to scour the books, go through things line by line.  Auditors are paid based on how many abuses or errors they uncover.  So it’s a win-win.  The auditor, if they do a good job they get a small percentage as a reward.  And the taxpayer wins by getting huge sums of money that would otherwise be lost that we can then spend to provide care to people who really need it, or we can use to reduce the deficit.

Now, through this effort, we expect to more than double the amounts we would’ve otherwise recovered — a couple of billion dollars over the next few years.  And I’m announcing my support for the Improper Payments Elimination and Recovery Act — that’s a mouthful — but this is a bipartisan bill — (applause) — is a bipartisan bill to expand our ability to do these audits, so we can prevent even more fraud and abuse and waste.

Now, the reason I’m bringing all this stuff up is because there’s been a lot of talk about health care lately.  And look, I’ll be honest, a lot of people, they’re confused, they’re saying, well, how can you help people get insurance who don’t have it without it adding to our deficit?  It’s a legitimate question.

Well, the reason is, is because so much of the money currently in our health care system is being misspent.  (Applause.)  Look, if you’ve got — if you’ve got a house and the roof is leaking and the windows are all letting through a bunch of draft and you get that cold winter and all the heat seeping out, and if you decide to spend on some new windows and fix your roof, that’s going to spend a little money, but you’d save money in the long run because you don’t have heating expenses, and those leaks aren’t ruining your furniture.

The same thing is true with our health care system.  We’ve got leaks everywhere — that you pay for, directly or indirectly.  And if we can have a smarter health care system, then yes, we can provide help to middle-class folks who need it, and at the same time actually reduce the burden on taxpayers.

Now, I know that during the health care debate opponents have tried to scare people, especially our seniors, into thinking that we are going after seniors’ Medicare benefits; that’s how Obama is going to pay for his plan.

When you look at the facts, that’s just plain wrong.  In fact, by saving billions of dollars of the sort we just talked about — waste and abuse — in Medicare, reining in waste and inefficiencies, we’re going to be able to help ensure Medicare’s solvency for an additional decade.  (Applause.)  This is just one example that speaks to how we’re going to stop wasting money through the health care system on things that don’t make people healthy — in fact, often take away from the care we receive, and take that money and make it work for the American people.  So Medicare will work better, provide better care because of these reforms.  Senior citizens who are dealing with the doughnut hole in the prescription drug plan — that plan will be filled in part because we’re not wasting money on stuff that doesn’t work.  (Applause.)  That’s common sense.

You know, I get a lot of letters from constituents.  I get about 40,000 every day, and I don’t read all 40,000 — somebody does — but what I’ve done is I’ve asked my staff to collect a sampling of 10 letters that I read every night.  And I will tell you that my staff is very evenhanded, because about half of these letters call me an idiot.  (Laughter.)

And at least half of them talk about health care.  And when the health care reform debate was really heating up, one of the things that I heard from a lot of seniors was, “Keep your government hands out of my Medicare.”  (Laughter.)  I heard this from a bunch of seniors.  They say, “I don’t want your government-run health care plan, and don’t touch my Medicare.”

And so I’d have to write back and I’d say, “Ma’am,” or “Sir, Medicare is a government program.”  (Laughter.)  “But we’re not going go weaken it.  We’re going to make it stronger.”

But I think those letters tell you something about what sometimes happened in this health care debate, because people have been hit with a lot of bad information.  And health care is really important.  And so people get worried and they get nervous.  But when you get past the divisive and the deceptive rhetoric, it turns out that most Americans are happy that two generations ago we made the decision that seniors and the poor should not be saddled with unaffordable health care costs or forced to go without needed care.  That was a decision that we made decades ago.  And it was the right decision to make.  (Applause.)

And by the way, when we made those decisions, folks were saying the exact same thing about Medicare:  “That’s socialized medicine, this is government-run care,” and blah, blah, blah.

Now, today we face a different choice, but it’s a similar choice to the one that previous generations faced, and that is whether we should help middle-class families and business owners that are being pummeled by the rising costs of health care.  See, back when the Medicare debate was taking place, seniors were having problems because they were no longer working, and people were getting their health care through their jobs.  And so it made sense to help them.  It made sense to help the poor who might not be employed.  But back then, middle-class folks, they were pretty secure.  If you were working, you had health care that was affordable.

But you know what’s happened over the last several decades.  What’s happened is, is that more and more businesses are saying, we can’t afford to provide health care to our workers because the costs are skyrocketing.  So they just drop health care altogether.  A lot of small businesses, they don’t provide health care to their employees anymore.  And large businesses, what are they doing?  They’re saying to you, we’re going to jack up your premiums, we got to increase your deductibles.  If you’re self-employed, you are completely out of luck.  If you’ve got a preexisting condition, you are completely out of luck.  And by the way, those of us who are lucky enough to have health care today, we don’t know if we’re the ones who are going to lose our job tomorrow, or suddenly it turns out that our child has a preexisting condition.  And we’ll be stuck in the exact same situation, even if we’ve got good health insurance.  (Applause.)

Now, everything I just said, if you talk to my opponents, they’ll agree.  They’ll say, you’re right, the health care system is broken.  For too many people it’s getting worse.  They will acknowledge that the status quo is unsustainable.  But you know what they tell me?  We had that big health care summit.  I know you guys watched all seven hours of it.  (Laughter.)  Yes, absolutely.  It was scintillating.  (Laughter.)  But you heard what they said.  They said, well, we agree with you that the current system is unsustainable, but this is just not the right time to do it.  They said, let’s start over, that’s what they said.  We just got to start from scratch.


THE PRESIDENT:  Well, let me tell you something.  The insurance industry is not starting over.  They just announced a 39 percent rate increase in California and a rate increase of up to 60 percent right across the border in my home state of Illinois — 60 percent in one year.  That’s the future.  That’s the future if we fail to act.

And by the way, I don’t recall any of these Republicans trying to do anything about insurance companies’ abuses during all the years they were in charge.  (Applause.)  Do you, Claire?  I don’t remember.  I don’t remember them doing anything about folks who needed some help when the government was running surpluses.

So I get a sense with some of these folks, it’s just never going to be the right time.  But the truth is, we have debated health care in Washington not just this past year, we’ve been debating it for 70 years.  You know who was pushing health care reform?  Harry Truman.  (Applause.)  Harry Truman was pushing health care reform.  And by the way, you know what they said?  They said, he’s pushing socialized medicine.  Harry Truman.

And over this past year we’ve been talking about it, every proposal has been put on the table.  Every argument has been made and everybody has made it.  And I know that people view this as a partisan issue, but the truth is, is that if you set aside the politics of it, and what was good for Election Day, it turns out that parties have plenty of areas where they agree.  And the plan that I’ve put forward is a proposal that’s basically somewhere in the middle — one that incorporates the best ideas of Democrats and Republicans, even though the Republicans have a hard time acknowledging it.

Now, there are some folks who wanted to scrap the system of private insurance and replace it with a government-run health care program, like they have in some other countries.  (Applause.)  We’ve got a couple — some applause here.  And look, it works well for those countries.  But I’ll just be honest with you:  It was not practical or realistic to do here, to completely uproot and change a system where the vast majority of people still get their health care from employer-based plans.

And on the other side of the spectrum there are those who believe that the answer is to simply unleash the insurance industry, and provide less oversight and fewer rules.


THE PRESIDENT:  And that somehow that’s going to drive down prices for everybody.  This is called the “putting the foxes in charge of the hen house” approach to health care reform.  (Applause.)  So whatever state regulations were in place, we’d get rid of those and so insurance companies could basically find a state that had the worst regulations and then from there sell insurance everywhere.  And that somehow that was going to be helpful to you.  All this would do would give insurance companies more leeway to raise premiums and deny care.

So I don’t believe we should give either the government or the insurance companies more control over health care in America.  I want to give you more control over health care in America.  (Applause.)

So my proposal builds on the current system where most Americans get their health care from their employers.  If you like your plan, you can keep your plan.  If you like your doctor, you can keep your doctor.  But my proposal would change three important things about the current health care system.  Now I want everybody to pay attention — I know it’s a little warm in here, but I want you to pay attention, so that when you are talking to your friends and your neighbors and folks at work and they’re wondering what’s going on, I want you to be able to just say, here are the three things Obama is trying to do.

First, it would end the worst practices of insurance companies — and it would begin to do so this year.  This year.  (Applause.)  Thousands of uninsured Americans with preexisting conditions will be able to purchase health insurance for the very first time in their lives or since they got sick.  (Applause.)  This year.  Insurance companies would be banned from denying coverage to children with preexisting conditions this year.  (Applause.)  Insurance companies would be banned from dropping your coverage when you get sick.  (Applause.)  Insurance companies would no longer be able to arbitrarily and massively raise premiums.  They would be subject to review.

Those practices will end as a consequence of health care reform.  (Applause.)

All new insurance plans would be required to offer free preventive care to their customers.  And if you buy a new plan, there will be no more lifetime limits on the amount of care you receive from your insurance company — (applause) — all that fine print that ends up getting folks into trouble.  If you’re a uninsured young adult, you’ll be able to stay on your parents’ insurance policy until you’re 26 years old.  (Applause.)  So a lot of folks, as they’re transitioning into the workplace, will have insurance.  (Applause.)  All right, so that’s part one of the plan:  insurance reform.

Part two.  For the first time, uninsured individuals and small businesses will have the same kind of choice of private health insurance that members of Congress get.  (Applause.)  If it’s good enough for members of Congress, it’s good enough for the people who pay their salaries.  (Applause.)

This should not be a controversial idea.  The reason that federal employees usually have pretty good insurance is because they’re part of a pool of millions of people.  So what happens is they can negotiate for really good rates because the insurance companies really want those millions of customers.  So what we’re talking about is setting up a pool for people who don’t work for the federal government — you, individuals, small businesses; they can be part of this pool.  And this is an idea that a lot of Republicans embraced in the past until I said it was a good idea.  (Laughter.)

So all this would drive down rates for those individuals and small businesses who aren’t part of a big company that get good rates.  And my proposal says if you still can’t afford it, even though now the premiums are lower than you can buy on your own, then we’ll offer you some tax credits to make it affordable.  And those tax credits would add up to the largest middle class tax cut for health care in history.  (Applause.)

So it’s estimated that this would drive down the costs for folks who don’t work for big companies — so they don’t get as good of a deal — by 14, 20 percent.  This is before the subsidies, before the tax credits.

Now, it’s true that this will cost some money.  It’s going to cost about a hundred billion dollars per year.  That’s real money, that’s a lot of money.  But most of that money comes from the nearly $2.5 trillion a year that America already spends on health care that we’re not spending well; that we’re spending badly right now.

So we pay for this proposal by getting at the abuse that we just talked about.  We eliminate wasteful taxpayer subsidies that go to the insurance companies.  Do you know that through the Medicare program, we are giving insurance companies close to $20 billion a year, about $18 billion every year of taxpayer money through the Medicare system.  And we’re saying, well, why do we do that?  They’re making a profit on their own.  And while some of what we save goes to helping the uninsured, most of it goes back to small businesses and the middle class who right now just aren’t getting a good deal.  It doesn’t make sense to me that people who are really poor are able to get Medicaid, but people who are working really hard and just not quite as poor, they don’t get a decent deal.  That doesn’t make sense to me.  (Applause.)

All right.  That’s the second part.  First part:  insurance reform.  Second part:  creating this marketplace where small businesses and individuals can get a good deal.

Third part:  bringing down the cost of health care for families and businesses and for the federal government.  Cost control.  Now, when you listen to the other side, they’ll tell you, we want to do more about cost, we want to do more about cost.  Well, let me tell you, we’ve incorporated almost every serious idea from across the political spectrum about how to contain rising health care costs.  There’s not an idea out there that we have not worked on, that we have not included in this proposal.

And according to the Congressional Budget Office — this is the office that is supposed to be the independent referee for how things cost, it’s not supposed to be Democrat or Republican — according to the Congressional Budget Office, people buying health plans in the individual market right now, they’d see their premiums go down 14 to 20 percent.  (Applause.)  I already mentioned that.

Now, here’s another thing.  A recent study by the Business Roundtable — that’s made up of all these big companies out there, they don’t — they’re nonpartisan, but it’s not like they’re just dyed-in-the-wool liberal Democrats, let’s put it that way; these are company CEOs — they commissioned a study and said the reforms could reduce premiums by as much as $3,000 per employee.  That’s their study, not mine.

Then the Congressional Budget Office said that the government would save a trillion dollars, reduce the deficit by a trillion dollars.  So think about it:  You’re saving money, employers are saving money, the federal government is saving money — not according to me, but according to these studies that were done by independent analysts.

So here’s the bottom line, St. Charles.  There’s no government takeover, unless you consider reining in insurance companies a government takeover — and I think that’s the right thing to do.  (Applause.)  There’s no cutting of Medicare benefits.  There’s just cutting out fraud and waste in Medicare to make it stronger.  (Applause.)

What we’re proposing is a common-sense approach to protecting you from insurance company abuses and saving you money.  That’s the proposal, and it is paid for.  And I believe that Congress owes the American people a final up or down vote on health care reform.  (Applause.)  The time for talk is over; it’s time to vote.  (Applause.)  It’s time to vote.  Tired of talking about it.  (Applause.)

Now, of course, folks in Washington, they like to talk.  And so Washington is doing right now what Washington does.  They’re speculating breathlessly, day or night, every columnist, every pundit, every talking head:  “Is this proposal going to help the Republicans or is this proposal going to help the Democrats?”  “What’s going to happen to the President’s poll numbers if the vote doesn’t go forward?”  “If it does go forward?”  “What will it mean for November?”  “What will it mean for 2012?”  “How’s the politics going to play?”

I heard the Republican Leader of the Senate the other day — he’s warning Democrats, you better be careful about voting for this; it could hurt you.  I don’t know how sincere the Republican Leader is about the best interests of Democrats.  (Laughter.)  He’s been very generous with advice.  (Laughter.)

You know what, here’s the bottom line, St. Charles.  I don’t know how the politics play.  I don’t know.  This is a hard issue.  It’s a complicated issue.  There is a lot of information floating around out there.  A lot of it is inaccurate.  The opponents have spent millions of dollars fighting it.  And people during recessionary times, they’re anxious and sort of thinking, gosh, can we really afford to change things right now?  Maybe we should just kind of stick with the status quo, even though we know it’s not working for us.

So I don’t know how the politics plays.  But here’s what I do know:  The American people will be more secure with this reform.  Our country will be stronger because of this reform.  (Applause.)  I don’t know about the politics.  But I know it is the right thing to do, and that’s why I’m fighting so hard to get it done.  (Applause.)

We’ve seen years — decades — where Washington just puts off dealing with our toughest challenges because it’s too hard, because we don’t know how the politics works.  And the will and the capacity to act, to do serious things in this country, starts just getting sucked away.  Just gets sacked by partisanship and political gamesmanship and debates about who’s up and who’s down, and how does this play politically — instead of asking what’s right and what’s wrong.  And we’ve seen terrible consequences — not just these last two years of turmoil, but a decade of struggle for middle class families.  (Applause.)

We can’t accept the status quo.  We can’t accept the same old/same old.  I won’t accept it.  Claire McCaskill won’t accept it.  Not when it comes to how we manage taxpayer dollars.  Not when it comes to how our health care system works.  Not when it comes to meeting the difficult challenges that we face.  And that’s why Claire and I are fighting to stop waste and abuse in our government.  That’s why Claire and I are fighting to pass these health insurance reforms.  (Applause.)  Now is the time.  Now is the moment.  Now is the time for us to leave for the next generation and generations to come a stronger and more prosperous country.  We are not backing down.  We are not quitting, St. Charles.  And we are going to get this done.  (Applause.)

Thank you.  God bless you.  And God bless the United States of America.  (Applause.)