American College of Physicians: Internal Medicine — Doctors for Adults ®

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Doctors object to enlisting patients in war on fraud

From the April 1999 ACP-ASIM Observer, copyright 1999 by the American College of Physicians-American Society of Internal Medicine.

By Phyllis Maguire

Physicians across the country are protesting HCFA's efforts to enlist Medicare patients in the war on fraud and abuse, predicting that they will lead to tensions between providers and Medicare beneficiaries.

The College has complained that HCFA's "Who Pays? You Pay" campaign, which is asking Medicare beneficiaries to check their monthly Medicare Summary Notice for any suspicious charges, is playing on patient misconceptions about fraud.

In late February, the Department of Health and Human Services (HHS) launched a campaign to get patients involved in its efforts to detect fraud. (For more information on HCFA's antifraud efforts, see "How to navigate the new rules on itemized statements," page 8.)

In a media statement, the College's Executive Vice President Walter J. McDonald, FACP, said that the campaign was based upon misleading statistics and perceptions concerning fraud, and that it could foster "a vigilante mentality" under the guise of fraud-fighting zeal. Physicians around the country echoed Dr. McDonald's concerns, fearing that the initiative will drive a wedge between physicians and patients and erode their foundation of trust.

Data show that the public already overestimates the magnitude of health care fraud. The American Association of Retired Persons (AARP), which is cosponsoring the "You Pay" campaign, has found in surveys that 80% of the country's adult population believe that health care fraud is either "extremely" or "somewhat" widespread. Another AARP survey found that 70% of adults believe that ending fraud and abuse will preserve the Medicare trust fund.

Critics are afraid that the HCFA campaign is playing upon such patient misconceptions. "The campaign is being couched in a way that suggests patients can't trust their doctors," said ACP-ASIM Regent Risa J. Lavizzo-Mourey, FACP, director of the Institute on Aging at the University of Pennsylvania Medical Center. While she applauds efforts to encourage consumers to monitor Medicare statements, she thinks the thrust of this campaign is to cast doubts about doctors in patients' minds. "I think it's a potentially malignant force and I'm very disappointed to see it happen," she said.

The AARP, however, counters that the campaign is legitimate. "We're not asking Medicare beneficiaries to self-practice medicine and determine what was unnecessary," said Lee E. Norrgard, co-lead of AARP's Medicare fraud team. Instead, he said, beneficiaries are being told to zero in on charges that seem "absurd," such as "when you have tennis elbow, but your Medicare carrier is charged for a wheelchair from a telemarketing firm."

AARP has outlined a three-step process for beneficiaries to handle questions: First call their doctor, then their Medicare insurer if their physician can't provide sufficient answers. If recipients are still convinced that something's awry, they are told to contact the Medicare fraud hot line at 800-HHS-TIPS.

Critics are wary of the government's use of financial incentives. HCFA is offering rewards of up to $1,000 for information leading to health care fraud convictions and recovery. HCFA officials claim, however, that rewards will not be given to tipsters who help uncover billing errors.

Mr. Norrgard argued that AARP is emphasizing the satisfaction of taking personal responsibility through monitoring Medicare statements, and not the possibility of financial gain. The campaign's aim is educational, he said, with the intent of stanching Medicare waste, which last year topped $12 billion in improper payments. Yet some claim that the tone of the campaign is more zealous than educational, a fact that troubles many physicians.

Physicians are also concerned about the volume of phone calls the campaign may produce. According to the College's statement, doctors may have to spend more time fielding questions about Medicare statements and less time treating patients.

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