The American Hospital Association and its state affiliates last week finished the first phase of their grass-roots campaign to drum up lawmakers' support for reining in federal anti-fraud initiatives.
Other AHA initiatives with a similar objective have failed. For example, last year the AHA called for a moratorium on new federal fraud investigations of hospitals under the False Claims Act. The proposal was quickly rejected by federal officials.
The AHA also sued the federal government in an attempt to derail a broad investigation of hospital billing for certain laboratory services. A federal judge threw the case out late last year and suggested the hospitals seek a legislative remedy.
The AHA and affiliates last week mailed the campaign's final batch of letters to members of Congress. They note: "U.S. Attorney General Janet Reno has said that the Justice Department is considering using the civil False Claims Act to target 4,700 hospitals nationally for Medicare fraud. That means that Justice believes that every hospital in the country that participates in . . . Medicare . . . is committing fraud."
The False Claims Act allows the government to seek fines of $5,000 to $10,000 and triple damages for every Medicare bill deemed fraudulent.
The letters ask Congress to "question the Department of Justice about its use of the False Claims Act to prosecute Medicare billing errors," and they seek "support for a legislative remedy to protect hospitals from intimidation and over-reaching ."
Already the campaign is bearing fruit.
A group of 17 Texas lawmakers last month sent letters to HHS Inspector General June Gibbs Brown questioning a "policy of alleging false claims (and demanding triple damages) when it may be a case of unintentional billing errors."
But the AHA wants more action. Richard Pollack, AHA executive vice president for federal relations, said legislation is needed to curtail federal investigators' ability to use the False Claims Act.
Pollack said such legislation could increase the burden of proof needed to apply the act or it could protect providers from fraud charges if they were following a fiscal intermediary's billing instructions.
So far, the AHA has not found a sponsor. According to one GOP aide, drumming up significant support might be difficult. The aide said legislation to curb use of the False Claims Act would have to apply to all government programs, not just Medicare.