Feds warn: Beware advice on illegal billing practices

Federal investigators told a Senate committee recently that some health care consultants are advising physicians about boosting their incomes in ways that often are illegal. Robert Hast, an investigator with the General Accounting Office, told the committee that investigators attended two workshops and found that some of the advice was "inconsistent with federal law and guidance provided by the Department of Health and Human Services’ Office of Inspector General."

Hast played a tape of a consultant advising doctors who discover errors in their favor to change their behavior in the future, but not to report the overpayments. The consultant said reporting the error is "the reddest of red flags."

Another consultant advised doctors to give preference to patients with higher-paying insurance plans. Medicare and Medicaid patients should not get the best appointment times, the consultant said. "So they get scheduled only 10 to 11:30 in the morning, and 2 to 3:30 in the afternoon. That’s it. Now there are always exceptions, but we didn’t want them getting the best appointment slots. We want the best appointment slots to go to the best payers."

Assistant HHS Inspector General Lewis Morris says his office is prosecuting several consultants for advising clients to pursue illegal billing practices. The Inspector General’s office also issued a "Special Advisory Bulletin" warning providers that relying on a consultant "does not relieve a provider of responsibility for ensuring the integrity of its dealings with the federal healthcare programs."