The government's upcoming amnesty program for teaching hospitals targeted in the latest Medicare fraud probe likely will pit hospitals against their most loyal physicians, MODERN HEALTHCARE*has learned.
In exchange for paying smaller settlements, hospitals that accept the government's leniency would have to supply federal investigators with Medicare billing records from their affiliated faculty practice plans, a government source said.
"We expect full and unfettered cooperation from hospitals, and that includes helping us find out which doctors have submitted claims," said the source, who requested anonymity. "If instead they choose to align themselves with docs who stole from us, they'll have bigger problems on their hands."
Robert Dickler, senior vice president of the Association of American Medical Colleges, said his group is aware of the program, which he called a voluntary audit program, and has been talking with the government about how it will be rolled out.
The AAMC wants the government's audit guidelines, which are being drafted, to be as clear as possible given the ambiguity of billing rules for teaching physicians.
As for the potential rift between teaching hospitals that participate in the program and their physicians, Dickler said such participation will require a "cooperative attitude" between the hospital and doctors.
The amnesty program, which has yet to be formally announced by HHS' inspector general's office, is being developed in conjunction with the government's latest fraud investigation of healthcare providers. The investigation targets teaching hospitals and their affiliated faculty practice plans that have submitted claims to Medicare for work actually performed by medical residents as part of their training.
The government says hospitals already are reimbursed for the work of medical residents through Medicare payments for graduate medical education programs. Claims submitted by teaching physicians for the same work represents double billing, it says.
The investigation came to light last December, when the 600-member faculty practice plan at the Hospital of the University of Pennsylvania in Philadelphia agreed to reimburse Medicare $10 million for alleged overpayments and pay a $20 million fine.
In March, MODERN HEALTHCARE*disclosed that the probe targets teaching hospitals nationwide, not just those in the Philadelphia area, as was first thought. Then, HHS officials confirmed the existence of the nationwide probe but kept mum on the amnesty deal.
The final details of the amnesty program are being worked out, and HHS Inspector General June Gibbs Brown is expected to unveil the program next month. HHS officials declined comment.
The program likely will be offered under the rubric of HHS' voluntary disclosure program the government created in May 1995. Under the program, healthcare companies that uncover internal evidence of Medicare or Medicaid fraud can turn themselves in to federal authorities in exchange for reduced financial penalties (May 8, 1995, p. 8). To date, HHS has extended the relief only to home health agencies, nursing homes and home medical equipment suppliers.