Sen. Charles Grassley is about to become a very popular man. Again. The 69-year-old Iowa Republican, who assumes the chairmanship of the powerful Senate Finance Committee this month, will be lobbied heavily by healthcare providers, insurers and patient advocates, all of whom will be promoting their side of the story and trying to sway Grassley's decisions.
But if they know anything about Chuck Grassley, a senator for more than 20 years, they already are aware that the Senate's only family farm owner and former sheet metal worker is somewhat of a maverick. They also know that it's not always easy to predict where he'll land on issues.
"I'm a conservative, but not an idealogue," says Grassley, who briefly held the same chairmanship in 2001 for four months before former Republican Sen. James Jeffords of Vermont became an independent, tipping the Senate majority to the Democrats.
"I'm a populist, but I have respect for entrepreneurs. And I'm as transparent as the transparency I expect from government."
While a loyal Republican, Grassley has earned a reputation as someone who will take on members of his own party, even the White House, over matters of principle. Few conservative Republicans, for example, can number among their campaign contributors trial lawyers, who usually support Democrats. But Grassley routinely draws donations from the plaintiff's bar. He is one of the few members of his party who has urged more government oversight of government contractors, including healthcare providers.
Among healthcare providers and their lawyers he is perhaps best known for co-authoring in 1986 the modern version of the False Claims Act, a Civil War-era statute known as "Lincoln's Law."
That law, which was enacted to prosecute and prevent fraud among Union Army vendors and suppliers, allows private citizens to sue on behalf of the federal government and claim a portion of any recovery.
Focus on fraud
Grassley's championing of the False Claims Act dates back to his early days in the Senate.
The former Iowa state legislator and congressman who unseated Democratic Sen. John Culver in 1980 says he backed into the government fraud issue.
"It started with efforts to freeze the federal budget across the board in the early '80s," the married father of five remembers. "Nobody wanted to take on the Defense Department. I learned about the defense budget and listened to a lot of people about the incredible waste there. We found a number of cozy relationships between the Justice and Defense departments. Some of those people were telling us to go easy on certain contractors. Whistleblowers were telling us we had to do something. A woman on my staff did some research on the False Claims Act and we decided to put some teeth into the law, which was gutted during World War II."
Grassley says at least 10 senators sympathetic to the Defense Department or its contractors put holds on the bill, procedural moves designed to delay or kill proposed legislation. And he says the Defense Department fought it tooth and nail. But amid a climate of press stories about $700 hammers and public indignation over wasted resources, the bill passed in 1986.
"After it passed, first the defense industry and later the healthcare industry tried to gut it," he says. But he says the law has successfully withstood legal challenges and has been upheld in court.
"The law has been effective," he says. "The proof is in the massive amount of money returned to taxpayers, which is measurable and is in the billions of dollars. What isn't as measurable is the deterrent value, which is many times more than the amount of money recovered or saved."
The government has recovered more than $10 billion since the law was amended in 1986, $5.9 billion from the so-called "whistleblower provisions." To date more than 4,000 whistleblower suits have been filed under the law, according to the Justice Department.
Stephen Meagher, a whistleblower lawyer with the San Francisco office of Phillips & Cohen, says that because of Grassley's support of the False Claims Act, the senator is probably the most important and indispensable public official in fighting healthcare fraud.
"His contributions are hard to overestimate," says Meagher, who represented two of the whistleblowers in the recently proposed $898.5 million HCA civil settlement. "It's doubtful that those 1986 amendments to the law would have passed or survived without his support and continued interest. Unlike some elected officials who have passed bills, he hasn't washed his hands and let go since his authorship, but he continues to monitor the law. His scrutiny of how the Justice Department, (the Centers for Medicare and Medicaid Services) and HHS' inspector general's office prosecute the law are examples of his continued interest. And that's been critical."
"We have to keep our eye on it," says the plainspoken Grassley, who occasionally favors wearing dark, conservative suits with cowboy boots and loud ties.
Although he doesn't believe the law has completely cleaned up fraud among government contractors, he says its legacy is strong.
"The False Claims Act has helped a corporate compliance culture blossom in healthcare and other industries and that wouldn't be there if the threat of an internal employee blowing the whistle wasn't so real," he says. "The downside is that there isn't enough protection given to whistleblowers as far as I'm concerned. There are people still getting fired for being patriotic. And many whistleblowers have been left to their own devices for years and haven't gotten the spirit of cooperation that the act was intended to provide from the government."
He conceded there's been another downside.
"We didn't mean for it to serve as a consultants' full-employment act," he jokes.
And Grassley says some federal officials in the mid-'90s were overzealous in interpreting the law.
"We can't be prosecuting honest errors," he says. "The law requires the government to prove a pattern of intent to defraud. And the government should look at undercoding as well as overcoding."
Steven Brenton, former president of the Iowa Hospital Association and now president of the Wisconsin Health and Hospital Association, says Grassley always has been concerned about unnecessary and excessive federal spending. "And on those issues he's never been bashful about taking on his contemporaries," Brenton says. "When it comes to the False Claims Act, he's like a mama lion protecting her cubs."
That protectiveness has spurred Grassley's publicized inquiries into how the Justice Department and the CMS are prosecuting the law. Grassley called CMS Administrator Thomas Scully to task in March 2002 for allegedly directing an end run around the law and allegedly intervening in the HCA settlement process. Scully formerly served as president of the Federation of American Hospitals, which represents investor-owned hospitals.
Scully denies the allegations and says he has cooperated with Grassley's committee and enjoys a solid professional relationship with the senator.
"Sen. Grassley and I have always gotten along fine," Scully says. "He created the False Claims Act and he feels with some legitimacy to be its patron saint. I believe in the law and from the beginning I've totally recused myself of any HCA matters. I have had absolutely no involvement with anything related to HCA, especially last month's settlement. And I would swear that on a stack of Bibles."
Scully says Grassley's frustration is derived from the natural institutional tension between the Justice Department and congressional oversight committees regarding how much the Justice Department can tell them about ongoing investigations.
Attentive to rural issues
While Grassley has strong opinions on fraud, waste and government accountability, when it comes to healthcare he is not a one-note song.
During his tenure as an Iowa senator, Grassley has supported Medicare reform and rural healthcare issues, most recently supporting a prescription drug benefit for Medicare beneficiaries. As longtime chairman of the Senate Special Committee on Aging, he pushed for greater government oversight of nursing home quality, spurring congressional hearings in July 2000 and sparking prosecutions, fines and closings of facilities that mistreat patients.
Grassley says that Medicare reimbursement equity will be a priority for him. He also says establishing a $3,000 tax credit for family caregivers and establishing greater incentives for purchasing long-term-care insurance policies are other topics on his to-do list. And he wants stronger enforcement of nursing home quality-of-care standards.
"This should be put in the context of a continuum of care for seniors," he says. "I've never met anybody who's said they're dying to get into a nursing home. We need to look at our healthcare delivery system for ways to keep people out of nursing homes as long as we can."
He also says the rural healthcare infrastructure needs to be bolstered through more equitable reimbursement and incentives for more providers to come to underserved areas through community health clinics and the National Health Service Corps operated by HHS.
John Rother, director of policy and strategy at the AARP in Washington, says he came to know Grassley while he was a staff director for the aging committee.
"Sen. Grassley is a person who others look to for leadership on issues of rural healthcare, Medicare and Medicaid policy and quality in long-term care," Rother said. "He has always listened to our concerns and has treated us fairly. We haven't always agreed on everything. We think there should be more funding for Medicare providers and for the prescription drug plan. But Sen. Grassley has never been someone who, if he disagrees with you on one issue, won't work with you on others."
Rother says the key to understanding Grassley lies in understanding his upbringing on an Iowa farm during the Great Depression. He says Grassley was raised in a thrifty household and taught to abhor waste.
"That's how he sees the world. I would use the phrase penny pincher. He's always been a fiscal hawk and that's how he approaches the world."
|Date of birth: Sept. 17, 1933, New Hartford, Iowa|
Family status: Married Barbara Speicher in 1954; father of five
Previous jobs: Operated parents' 80-acre farm; sheet metal shearer; assembly line worker
Education: B.A. 1955, M.A. 1956, political science, University of Northern Iowa Doctoral work, University of Iowa
Elected Offices: Iowa Legislature: 1958 U.S. House of Representatives: 1974; U.S. Senate: 1980
Committees: Chairman, Finance; member, Judiciary, Budget, Joint Taxation; co-chairman, Caucus on International Narcotics Control