Debt Clock Ticking

Floor Speech

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Mr. SCHWEIKERT. Honoring Deano's Italian

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Mr. SCHWEIKERT. Mr. Speaker, I thank my friend from Georgia.

Mr. Speaker, we are going to actually try to do something that is a little complex, so I apologize. I apologize for those trying to keep track.

If I start speaking like a machine gun--once again, I have had a stunning amount of coffee--just wave at me, and I will slow down.

I am going to try to actually explain and walk through what we talk about constantly, and that is waste and fraud. I have got three silos here, and I am going to try to fight for some understanding:

What is real in its fiscal impact.

What is sort of commercial fraud. Hey, we screwed up in the way we wrote a piece of legislation. The administration, the bureaucrats actually have allowed leakage--some of the leakage being hundreds of billions of dollars.

And over here are bad actors, you know, the group from Nigeria that has actually been conning unemployment fraud like we went through during COVID.

I also need to actually try to explain debt and deficits when our borrowing is stunning. So I was going to just start with this article. It is something simple, but I am going to use it as a benchmark.

This convicted felon gets a million dollars a year to sell obsolete internet services. You paid for it. So we have a con artist that set up an internet company, got a government contract. He gets a million dollars a year. It is outrageous. We should actually have the technology, the discipline, the way we write legislation, the way we do our appropriations to stop it. But you have got to understand a million dollars is what we borrow about every 12 to 15 seconds.

I need to put this in perspective, because so often here we get our brothers and sisters, Members of Congress, come behind these microphones, and we talk about what we are going to save on something. They don't seem to understand the burn rate. I think yesterday, we hit $94,000 a second in borrowing. So often the debate here, more money has been borrowed in the debate than the actual piece of legislation is going to save.

So let's actually try to walk through this and walk through these sorts of silos and then understand the punch line. I am going to do this three or four times.

A number of the things you would consider fraud, I consider fraud. There are lobbyists outside in this hallway, it is their client's business model. That is what makes this so difficult.

When you get groups from even your home district coming and saying, ``David, you don't want to reform this. That is our business model. We would have to change things,'' that is actually the real punch line when we use the term ``waste and fraud.''

Let's start with the board we often start with just so, once again, we have a benchmark of understanding. Your country is going to borrow about $2 trillion this year, and there is some noise in that number. It is actually--in some ways, we would score it as more in the Joint Economic Committee because we actually are crediting ourselves back some of the student loan money, but let's just stick with $2 trillion.

Do you see here in the blue? That is really what we vote on, nondefense, discretionary, and defense. Most of this red, almost all of it, is formulaic, but this is actually where much of the fraud is. Maybe that is the reason we don't touch it enough because the fraud is in Medicare, the fraud is in Medicaid, and the fraud is in other programs that are on autopilot. They are formulaic.

You reached a certain age. You get this benefit.

You have paid into the system. You get this benefit.

You fall under a certain income. You get this benefit, except within there, particularly in the Medicaid system--you have seen the analysis the Joint Economic Committee has done, or my joint economic Republicans have done over the last year on the number of ways States--States--are the driver of the fraud.

So let's actually walk through that.

If I came to you right now and told you that New York, the number of home healthcare aides--this is a Medicaid program where grandma is poor, she needs help, I have someone at home who needs help, and there is a program that came really out of COVID or was expanded out of COVID where I can actually hire my friends, my families, my nieces, my nephews.

What happens, for every 1,000 residents in New York over age 65 in 2024, which is when we have the data, for New York, I have 171 people. So think of that: 1,000 people over age 65, I have 171 people receiving a check for this program. I have shown some charts here in the past that this was the number one job creator, I think, in New York City over the last couple of years.

Is that fraud? I think it is, but it is leakage in the design of the system. We are being cheated by the State of New York, and then you start to take a look. Well, New York is 171, but California, for every 1,000 people over age 65, they have 139 people receiving these checks.

The fascinating thing is that when we first exposed this months ago-- and we had Secretary Kennedy in front of us about a month ago and we actually talked about this in the hearing, and he said that it is one of the most outrageous things that he has ever come across in his time at HHS--the month before that, my office was full of people angry at me. There are people buying editorials.

That is one of the great scams right now is to set up AI, you put up an editorial, and there is almost anyone who will publish it because that is actually a lobbyist for this leakage, and this is billions and billions and billions and billions of dollars.

Remember, if New York had the same cost of its Medicaid system--not Medicare--Medicaid--this is healthcare for the poor--and they had the same average cost as the rest of the country, it is $50 billion a year. It is $50 billion a year.

So at one point, I showed you the article. It is outrageous. It is $1 million, about 15 seconds of borrowing. We are going to borrow about $7 billion today, so $50 billion starts making an impact. Starting to understand the scale of these numbers, and you start to realize that the top 15 producers by spending per claim, you start to actually look at some of the things.

California actually has some magic. They must have some magic with their Medicaid system because they are able to create their own codes.

Within those codes, we have one that is called Medi-Cal Personal Care Services Program, and this has been around since--2019 to 2024 is my data. On average, that code costs $876. Most of that money is paid for you by Federal taxpayers.

Is this waste and fraud? Well, it is unlike any other State. It is unlike any other code. This is an example, when you hear the politicians say ``I am going to get rid of waste and fraud,'' and we make it sound like it is somebody snuck across the border and stole money or someone on the internet from the other side of the world stole money, all of those are true, but it is the design of the system that we have developed.

In the end of this stack, I am going to walk through a series of solutions, but understand that when we tried to just trim down some of the growth of Medicaid spending last summer and the left just attacked, attacked, attacked, and we would show, but what about this fraud, what about this fraud, what about this fraud, the discussion goes silent.

It is in the math. This stuff was being audited during the last Democratic nomination. We just never fixed it.

So you start to take a look at ``Top 15 Producers by Medicare Claims,'' and you start to look back to the personal care. It turns out that there were 1,000,257 claims filed under this. The scale--to understand the scale of some of these frauds, this is in the billions, and we allow this.

Does this meet your definition of waste and fraud, because HHS--we are going to walk through a series of things that MedPAC has tried to identify for years that we can't seem to get enough votes here to even run a piece of legislation to try to fix it.

Look, a couple more of these boards, and then we are going to have some fun with some headlines, which is something I almost never do, but I am trying to find a way to explain most of the leakage in this government.

It isn't some dodgy person in a dark room. It is actually how we are administering our programs and how poorly we are doing our jobs.

All right. ``Top 15 Producers by Medicaid Spending.''

Personal care services. Think of this: $139 billion from 2019 to 2024. It is $139 billion. That starts to add up to be real money. Maybe instead of screwing around this place where we are trying to do rounding errors or covering seconds of borrowing--which even in some of the debates earlier today, that is what we were doing--how about we start going after the things that have b's in front of it. I am going to show you a couple where there are t's in front of it, trillions in front of it.

If we are going to actually try to convince the brothers and sisters, the taxpayers, the voters, and the American citizenry of what is going on--debt and deficits and demographics in this State--that in a little over 6 years, Medicare trust fund is empty, and hospitals, those that get their Medicare part A money, are going to take a 12 percent cut, and guess what is also happening around this same time. The Social Security trust fund is empty, and people on Social Security, under the current law, are going to take a 24 percent cut, and we are going to double poverty.

How are we going to turn to people and say that this is over $630 billion to fix it in just a single year, and the next year is more and the next year is more? How many people are going to look at us and say that you have not taken care of the waste and fraud problem. How am I going to trust you to actually make me take a cut or make me pay more taxes or redesign the systems or do other things? We have to build some trust, and you build the trust by stopping this insanity.

Let's actually have a little bit more fun here. The New York Post headline, ``Notoriously Fraudulent New York Health Program Lost $1.2 Billion to Scammers and Middlemen.'' It was ten times--ten times--the money stolen in Minnesota.

Why haven't you heard about this? If scammers are bleeding our Medicaid systems around the State, why is it so hard to actually say-- we hold hearings on this. We have discussions about it, and then we produce a piece of legislation, and it is almost impossible to get sponsors on it because the next moment, it turns out that some of these middlemen that you and I would consider fraudsters hire lobbyists or actually bring groups of people here saying ``But that is our business model.''

You start to look at other things.

You start to look at other things, City Journal, ``Gavin Newsom's Empire of Fraud: California has lost at least $180 billion to fraud, according to officials and experts.'' It is program after program after program after program. $180 billion is real money.

Is the California delegation willing to help us fix this?

Here is your problem. You start to look at some of these things: unemployment fraud, $32.6 billion; Medicaid fraud, that one was only $178 million; homeless spending, let's see, billions and billions, doesn't actually give me a number.

You start to look at these things, and the waste and fraud are in the design of our programs. There is the fraud where somebody stole your Social Security number and did this, but the real money is how poorly we designed the programs that are meant to help our brothers and sisters, particularly those in poverty.

Let's have some more fun with this, if you call this fun. CalMatters, sham hospice scheme--remember, this is something my team--I chair the Oversight Subcommittee in the Ways and Means Committee. We have been now working on this for months and months and months. ``Sham hospice schemes are bilking Medicare,'' and some Medicaid, ``and harming California seniors.''

We actually believe this scheme--if you have been reading the papers, L.A. Times and I believe The Wall Street Journal have done stories on this. The amount of fraud, particularly in L.A. County, on hospice-- these are some of the most frail in our society. These are supposed to be the brothers and sisters we are loving as they are near ending life, except there is an entire fraud network.

I am going to actually show you--let's just talk about it before I try to show you. Someone finally did a little bit of data and found there are hospices where there are half a dozen, a dozen, two dozen at the same P.O. Box, and it went on for years.

Are we really that moronic to not run a simple data system and say: Wait, does this make sense? I have multiple hospices billing from the same P.O. Box. Does this make any sense?

Let's take a look at some more headlines: HHS Office of Inspector General report highlights CMS potentially overpaid Medicare Advantage organizations $462 million based on current unreported--I want to explain this one. Let's get a little complicated.

This is what they call MedPAC. This is the group of experts and auditors that look mostly at Medicare Advantage. Medicare Advantage is now 55 percent of all of our seniors who choose Medicare. They choose not part A, part B, but they go on what is called Medicare part C. That is Medicare Advantage.

In here, the latest report says, it comes in about 114 percent higher than fee-for-service. Medicare Advantage was supposed to come in at 95 percent of the cost. That difference, about $1.6 to $2 trillion over 10 years, it turns out it is real money.

How many Members of Congress have bothered to actually break this binder and read these MedPAC reports?

I introduced a piece of legislation a year ago to not cut services but to get rid of the risk scoring and the star rating, all the ways it was being defrauded, and that is what this board is about.

What happens when you have people in Medicare Advantage is that the insurer is going out and saying an acute stroke diagnosis code, except the data says it is a fake code. It is not something anyone has. That is how they are defrauding Medicare Advantage.

It is not a cut of services we are talking about. Yet, the number of lobbyists and the number of social media platforms that are somehow paid by those PR firms beat the crap out of those of us who have been trying to fix it.

Is this what you consider waste and fraud? Of course, it is. The difference is, those of us trying to fix it have to take on an army of people who make their money from it. That is actually, if you want to start to stabilize, even demonstrate to bond markets we are starting to take serious our leakage, our bleeding, our borrowing--remember, we are going to borrow $7 billion to $8 billion just today.

Where are my brothers and sisters here who will tell you how conservative they are, how tough they are, how truth-teller they are? How many of them are going to sponsor the legislation to help me fix this? So far, for almost 1 year, not a single sponsor other than myself.

Let's actually go through some more. Let's go through my home. Actually, no, let's do Minnesota first. Minnesota is always fun to go through. All right, 5 Eyewitness News: ``Audits--Lack of security reviews left Minnesota's SNAP system vulnerable to breaches, fraud.''

If you have read the story of nutrition support, we are trying to help the most vulnerable in our society, and it is full of fraudsters and fraudsters and fraudsters. How does someone not catch it when the same Social Security number is used over and over, when there is no Social Security number, when the same location has more people signed up for a benefit than there are people in that immediate area?

Keep that in mind because I am going to walk you through some of the solutions, but this stuff is absolutely outrageous, and then you start to take a look. Channel 7 Eyewitness News: `` `Ghost students' can steal your identity, enroll you in school, and take loans out in your name.''

We had people getting student loans who don't exist. Many of them had been buying your personal ID, your personal information, on the dark web, signing you up, putting you in debt. Then, you get to figure out how to unwind it as they are walking away with the money. This is another sense of the incompetent design in these programs.

All right, a little bit more, and this one, I happen to actually have had a fascinating experience with: ``Arizona sober living crisis: 140 indicted in billion-dollar Medicaid scheme.'' We think it is $2.8 billion.

Let me walk you through this. We call this the sober living home scam in Arizona.

Two Christmases ago, this last Christmas--we have sort of a family tradition. We go up to the Navajo Nation. We will call it the Nation. My parents used to do some work up there more as part of a church group. We have actually been up there and installed Starlink satellite dishes so that some of what we call chapter houses actually could have broadband, so they could have telehealth. My little girl has actually helped to do sheep herding.

It is a fascinating place. It is monstrous. I have had friends on the Navajo Nation come up to me and say: David, you realize my uncle disappeared 7 years ago? A van showed up here in Kayenta. They were recruiting people who might have had a drinking problem. They put them in the van, and they disappeared.

It turns out, they were being driven down to Phoenix, being stuck in a sober living home, being billed to the Medicaid system, which we call AHCCCS, Arizona Health Care Cost Containment System. Then, when the benefit was over, they were thrown out and rolled to another sober living home.

I had multiple acquaintances, friends from the Navajo Nation, say they have family members they can't find. They have disappeared. This is beyond the fraud of stealing $2.8 billion. Most of it actually isn't State money. It is also Federal money because of the way the match works.

There are people who have died. People have lost their lives because of how criminal this was, and it went on for a decade.

Then, our model is, we are going to indict a bunch of people. We are never going to get the money back. Almost none of these people will ever really go to jail or prison.

Have we lost our minds? Yes, we have.

DOJ announces a record-breaking take down of healthcare fraud schemes--okay, let's actually walk through a couple. The Justice Department has cracked down on a Pakistani national who allegedly orchestrated a $650 million fraud scheme in Arizona's Medicaid system.

How does this happen? How many times have you actually heard the attorney general, the county attorneys, these things, get up and say: We finally busted a fraud scheme that has been going on for years and years, and there is this much money missing. Now, all the money got shipped overseas, so we are not going to get any of it back, but we are going to file indictments on people who are not in the country anymore or were never in the country.

Have we lost our minds?

So here are a couple more of these because I am under a clock here. ``DOJ and CMS healthcare 2025 fraud crackdown.'' If you take a look at--and you have got to give the Trump administration, you have got to give Kennedy, you have got to give Dr. Oz credit because they are trying. Look at the chart. $1.3 billion and trying to crack down and stop some of the fraud.

But here is your problem: Just Medicare will spend $1.1 trillion this year.

So you have got to understand the scale. $1 billion is a stunning amount of money. A trillion is a thousand billion dollars. So start to look at these.

Now, this one I wanted to use as an example of how perverse Washington, D.C., and Congress have become. Let's look at this headline: ``Duplication of radiology imaging studies . . .''

What is the cost? My economists last year, we did--and it is a rough estimate--we were coming up with $25 billion to $35 billion in duplicative scans. You bust up your knee. You are out snow skiing. You get an MRI on your knee. Then you go to your hometown, and what is the first thing that happens? They redo the scan. CTs, MRIs, ultrasounds, X-rays. We have been proposing a simple idea. Take the scan when you get it. Attach it to your smartphone, and it travels with you. When you get to your doctor or your next appointment, they hit a button, and, boom, it is up on the big screen, and they can see, oh, yes, you have a fracture or you don't have a fracture.

Let's say at the top end my economist came up with $35 billion. I have already had multiple lobbyists in my office doing everything they can to stop that piece of legislation from ever getting a hearing because it turns out the duplicate scans are their business model.

So the point I am trying to sell here is: You and I, we go out on the stump, and we say we are going to go after waste and fraud, except the lobbyist in the back of the room is pissed at us because that fraud that you and I know does not make you healthier, does not make society better, does not provide an actual service is their business model.

``South Florida man sentenced in $2.2 million Medicare fraud and money laundering scheme . . .'' How many times have you picked up a newspaper publication or gone online and heard the stories about durable medical equipment fraud in South Florida. How is it possible it still goes on in a time with the technology we have.

Let's see, what else do I have on this one. ``Pasadena clinic receives $34 million in Medicare skin graft scam . . .'' Oh, this one was fun. It turns out we spend about 4, 5 years here trying to stop this, and they lobbied. It was one of the craziest things ever. Companies that ended up getting indicted were here with their CEOs lobbying us not to reform the system. This is where they would grow skin--diabetic retinopathy, these things, you know, skin patches, and all the sudden the price skyrocketed because the way the codes and the billing worked.

Eventually CMS had to come in and do Congress' job for them because Congress was so incompetent we couldn't actually do it. CMS came in and said we are just stopping it. We are going to allow this handful of companies to do it because at least they have some trusted history, and they were screaming at us.

It turns out when we did the research on them, the number that were absolute fraudsters--billions and billions of dollars were stolen. Once again, the Medicare trust fund is gone in 6 years, and we are not fixing these things.

Look, I am going to do a little skipping to the end because we are running out of time. Please, give CMS some love and support because working with my office we are finally starting to act like professionals and do things that the private sector has been doing for 20 years.

Here is a simple example. How many of you have a credit card? How many of you have ever used your credit card in a spot you are not normally at? How many of you, the moment you start using the credit card you start getting text messages and phone calls saying: Hey, is this actually you? That is a data system from 20 years ago. You are telling me that as we start to protect consumers and strengthen the programs, as we are starting to actually build models to start to protect and stop some of the bad payments, we don't have the technology? Of course, we have the technology. It is off-the-shelf technology.

We have a data person who has come to our office multiple times who is an expert in stopping fraud in healthcare. He said: Do you realize that there is a package that is $1,500 a month that would have stopped that sober living home fraud in Arizona? We would have seen that things don't match. The addresses don't match. The Social Security numbers don't match. There are multiple billings that roll and roll and roll.

When you have $11.7 billion saved just by the Treasury Department building a system that is sort of a do not pay list--let me give you an example that is from 20-plus years ago. Twenty-plus years ago I was the Maricopa County treasurer. We did this thing called positive pay, and it wasn't new technology. Here are our payees, the people we are going to pay checks to, we owe, because as the county treasurer you are the guy issuing the checks to pay for things. And over here is the list. When they didn't match, we didn't pay. That is 20-plus-year-old technology. Treasury has started to do a version of that, and it has already saved over $11 billion stopping fraudulent checks going out the door.

I want to make an argument in my last couple minutes before I hit the end of my time. What we do in government is insane. How many of you would build a business model where I am going to pay 6 percent, 7 percent of my payments are going to be fraud, but don't worry about that. Eventually we are going to hire a bunch of auditors. Then we will hire some lawyers. And then we will hire some law enforcement. And then we will try to go recover the money. Of course, we never actually recover the money. And most of the time we never get to put someone in prison, but we will get to do great press releases.

The age of hiring buildings full of auditors and lawyers is over. We live in the time of technology where these checks should never, ever, ever--the fraudulent checks should never get out the door. If you read any of the data magazines or articles or talk to some of the experts we are starting to develop here, we can catch this and stop it.

Mr. Speaker, the argument I am trying to make here, and if I haven't done it particularly elegantly, I am trying, is we need the public to believe we have finally woken up and become great stewards of their money. The reality of the waste and fraud is huge, but the scale of our borrowing, the scale of our debt, which is driven by our demographics-- next year, we are going to have fewer under 18 than we had 20 years ago and double the number of 65 and up. In 28 months, over half of Federal spending will go to our brothers and sisters who are 65 and up.

We are going to have to deal with the reality of our demographics and our math. Maybe the public will believe us when we can also say we stopped the scam artists. We stopped the missed design. We stopped the way we have screwed up the model on Medicare, Medicaid, and so many of the programs which were designed to help people and not enrich fraudsters.

Mr. Speaker, I think we are up against time, so I yield back the balance of my time.

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