American Hospital Association President Richard Davidson not only found himself barking up the wrong tree, he got nipped in the leg at the same time.
Federal fraud fighters' massive raid last week on Columbia/HCA Healthcare Corp. facilities-about 35 search warrants were served-wipes out much of the sympathy the AHA attempted to muster when it called for a moratorium on certain types of healthcare fraud investigations.
Davidson is calling for a six-month freeze on False Claims Act probes because the federal bureaucracy has "accused virtually every hospital in America with attempting to commit fraud against the Medicare program." Furthermore, he said, the gumshoes are employing heavy-handed tactics that amount to extortion.
Healthcare fraud is a serious topic in law enforcement circles these days. Whether it's organized crime's alleged infiltration of the medical delivery system or an overzealous billing clerk upcoding a DRG form, the government is determined to thwart the forces of evil. FBI Director Louis J. Freeh even puts a price tag on fraud, saying it costs the economy $44 billion a year.
In addition, a General Accounting Office report released last week estimated that 11% to 14% of all Medicare payments in 1996 were for fraudulent or wasteful claims.
Congress has responded to this kind of information by bolstering the healthcare fraud budget by $104 million. So don't expect Uncle Sam to call off the dogs anytime soon. Busting a wayward caregiver brings satisfaction to politicians and bureaucrats. Raiding hospitals of America's biggest healthcare company guarantees major headlines.
All this money and rhetoric leaves providers perplexed. Some healthcare systems are turning to silk-stocking law firms and pricey consulting agencies for assistance on how to comply with regulations. Others pine for self-regulation. The mood is equal parts panic, uncertainty and fear.
The complicated rules that determine how HCFA reimburses providers are a big part of the problem. The complexity is perhaps the best argument for competitive bidding, risk assumption and capitated payments for those treating Medicare patients.
Organizations willing to deliver value-based medical services to government patients at a prearranged price should be rewarded. Companies that have a history of deceiving patients and HCFA should be unable to participate in the process. Individuals convicted of cheating Medicare should face prison and pay personal fines. Those are the kinds of rules everybody can understand.