Feds train 10,000 elderly as Medicare fraud spies
Feds train 10,000 elderly as Medicare fraud spies
American Medical Association says program pollutes integrity of doctor-patient relationships
Last week, at locations across the country, more than 10,000 senior citizens got their marching orders from HCFA and the FBI: Scrutinize any Medicare billing information you receive, grill your physician if something seems fishy, and rat him or her out to the feds if the answers you get don’t add up. The reward for this detective work? At least $1,000 per case.
The Chicago-based American Medical Association (AMA) has led the charge against the program, which received strong support from the American Association of Retired Persons (AARP) in Washington, DC. While stressing that the organization doesn’t tolerate "genuine fraud," AMA president Nancy W. Dickey, MD, says that understanding the difference between fraud and a simple mistake is tough enough for the experts. Elderly amateur gumshoes with reward money on their minds could clog the system with invalid tips and ill-advised lawsuits.
"This is a big problem," says Vicki Myckowiak, JD, an attorney with Steinberg, O’Connor, & Burns in Detroit. "Because some Medicare beneficiaries have nothing better to do than sit there and misunderstand their bills."
At the two-hour training sessions, government investigators taught Medicare beneficiaries how to file qui tam suits against physicians on behalf of the government. In addition to the $1,000 bounty, beneficiaries could get up to 30% of any damages awarded by a jury under the False Claims Act — which can penalize physicians with up to $10,000 per case as well as triple the damages sustained by Medicare. Medicare contractors will attempt to screen the expected flood of fraud allegations from seniors taking part in the program.
"Sending patients out to fight Medicare fraud with little more than a baseball cap, a magnifying glass, and an 800 number trivializes real fraud," Dickey says. "This broad-brush approach to weeding out a few bad apples threatens to taint the vast majority of honest physicians whose biggest challenge is getting through mountains of Medicare paperwork so they can spend more time with patients."
Indeed, physicians’ biggest concern is that the anti-fraud campaign will corrupt the doctor-patient relationship by destroying trust between physicians and those they treat. Dickey says the campaign itself will probably create "an adversarial tension" that is "contrary to quality patient care."
Steve Hahn, who helped to spearhead the campaign at AARP, says such concerns aren’t valid. "We’ve always said that the majority of physicians are honest," he says. "And honest providers have nothing to worry about." He adds that, although the AMA has vehemently opposed the campaign, other provider organizations have endorsed it.
And he denies that the program will have a chilling effect on physician-patient relationships. If anything, he says, it will encourage patients to become more interested and involved in their care and lead to a greater level of communication between patients and physicians.
The program, which AARP calls a "Medicare Neighborhood Fraud Watch," advises Medicare beneficiaries to check all Medicare statements they receive in light of three questions:
Did you receive the service or product for which Medicare is being billed?
Did your doctor order the service or product for you?
To the best of your knowledge, is the service or product relevant to your diagnosis or treatment?
Myckowiak says she’s particularly troubled by the third question, which essentially asks patients to make a determination of medically necessity that they’re almost certainly not qualified to make. "How’s a patient going to know that?" she asks. She adds that the only effective way physicians can deal with potential misunderstandings on the part of patients is to educate them beforehand, explaining exactly what’s being done to them and why. (See related story on how to deal with patients’ questions, page 3.)
According to program guidelines, if the patient answers "no" to any of the three questions, and you the physician can’t explain away the concerns, the patient should report the questionable charges to the local Medicare carrier for "clarification." AARP also says patients "shouldn’t hesitate" to report a questionable charge to OIG’s Medicare Fraud Hotline (800-447-8477).
The AMA counters the program amounts to nothing more than a "public relations gimmick" on the part of AARP and the government, and that federal investigators would be better served by working with physicians and other provider groups to develop "targeted strategies for rooting out fraudulent conduct."
"The fact is," Dickey says, "the government simply does not know the split . . . between genuine fraud and unintentional billing errors caused by hideously complex, incomprehensible government forms. [This initiative] shows that it would rather threaten physicians with harsh rhetoric than educate them with clear answers."
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