The Association of American Medical Colleges' effort to get federal agents off the backs of teaching hospitals and their faculty practice plans began to pay dividends last week when a top House Republican publicly questioned for the first time whether the agents were treating providers fairly.
HHS' inspector general's office is conducting a nationwide investigation of the Medicare billing practices of teaching hospitals and their physicians. The investigation focuses on whether physicians improperly billed Medicare for work done by medical residents. HHS considers that to be double billing unless a physician was physically present when providing instruction to a resident. The department says Medicare already pays for the work of residents through the program's reimbursement for hospitals' graduate medical education costs.
The investigation began more than a year ago, but the Washington-based AAMC didn't develop a plan of action to defend its 280-member teaching hospitals until last month. The plan calls for meetings with lawmakers while preparing for possible litigation against HHS (Jan. 27, p. 6).
In a hearing last week on the inspector general's fiscal 1998 budget, Rep. John Edward Porter (R-Ill.), chairman of the House Appropriations subcommittee that oversees HHS spending, said he wanted to know whether HHS agents were unfairly reviewing physician billing practices using billing standards that weren't in effect at the time.
Speaking to Inspector General June Gibbs Brown, Porter warned that HHS auditors should not be heavy-handed when dealing with teaching hospitals subject to investigation.
"I think you'll run into serious problems here in Congress if that's the word coming back from teaching hospitals," Porter said.
Brown responded: "I recognize the valuable contributions that teaching hospitals make to the advancement of medicine in this country. (But) if money has been inappropriately paid to any provider, those payments should be recovered and returned to the Medicare trust funds."
Whatever effect the AAMC's effort is having, it came too late for University of Michigan Hospitals in Ann Arbor, which on Jan. 31 received notice of an HHS audit of its billing practices.
Interim Dean A. Lorris Betz, M.D., said the audit for possible double billing will cover the period from January 1991 to December 1996, according to a report in Crain's Detroit Business, a sister publication of MODERN HEALTHCARE. The system has until the end of February to provide the inspector general's office with preliminary information such as organizational charts, clinical-practice bylaws and Medicare identification numbers.