The Association of American Medical Colleges is at last confronting a high-stakes federal probe of Medicare billing by faculty practice plans at teaching hospitals.
The investigation has had the AAMC's members panicking for many months.
Speaking softly but ready to swing a big stick, the AAMC, based in Washington, is seeking meetings with HHS officials to educate them about the investigation's fallacies. It also might take its case to Capitol Hill to urge lawmakers to intervene on the AAMC's behalf.
AAMC lawyers, meanwhile, are laying the groundwork for a possible lawsuit against HHS if the lobbying efforts fail, said Robert Dickler, AAMC senior vice president.
The federal investigation focuses on whether teaching hospital physicians were justified in billing the Medicare program for work done by medical residents. HHS considers that to be double billing unless the teaching physician was physically present providing instruction. That's because payments for the work of medical students are included in hospitals' reimbursement for graduate medical education costs.
Teaching hospitals fear the investigation because of the huge fines attached to the two settlements produced to date. In those cases, providers paid double and treble damages for fraudulent bills, bringing the government a total of $42 million.
Ten months after learning the probe would be national in scope, the AAMC last week released an eight-page brief on its policy position.
The AAMC represents 280 teaching hospitals. Although the probe looks at Medicare bills submitted by physicians, teaching hospitals are affected because their prestigious faculty practice plans are typically involved in an investigation and the feds contend those hospitals already have been paid for the work of medical students.
So far, the government has told about 40 faculty practice plans at major teaching hospitals to expect audits or voluntarily provide billing data to federal investigators, Dickler said.
The AAMC says Medicare billing regulations regarding teaching physicians were confusing until recently, so providers shouldn't be accused of deliberately filing false claims. Acknowledging some confusion, HHS published new billing rules last year to clarify the matter. The AAMC contends HHS is unfairly applying the new rules to old bills.
Dickler said some AAMC members have called for more aggressive action on its part, while others believe its new briefing paper is too aggressive.
"I think we hope by shedding light on this, people will take a different look," said Susan Waltman, general counsel for the Greater New York Hospital Association, which will work with the AAMC. "I believe as an initial position the best way to get listened to is to be educational."