The healthcare industry is trying to form a new coalition to fight back against what it considers over-aggressive federal anti-fraud efforts, MODERN HEALTHCARE has learned.
But the coalition's members are having a hard time deciding how to fight and how hard. There's also some underlying tension over who should be in the group.
The effort to join forces comes at a time when Medicare and Medicaid anti-fraud efforts are reaping millions in overpayments for the government, and federal investigators are seeking even more weapons with which to pursue providers (See related stories, p. 8).
The fledgling alliance, tentatively named the Healthcare Accountability Partnership, has had three organizational meetings to date. Groups that have attended include the American Hospital Association, the American Medical Association, the American Medical Group Association and the Federation of American Health Systems. Overtures also have been made to managed-care organizations.
The meetings have been held at the Washington office of pharmaceutical giant SmithKline Beecham, which has been a favorite target of federal fraud investigators in the past.
Representatives of several of the groups, speaking on condition of anonymity, said a formal announcement of the confederation would come within several weeks.
There is evidence, however, that the parties involved are not entirely on the same page.
Some of the groups want the coalition to be a way of getting their representatives in contact with federal investigators, possibly through a series of seminars or symposiums.
Others want the group to focus on compliance programs.
Still others want the group to be more aggressive, pushing a legislative agenda and working to rein in federal healthcare fraud investigators.
Many of the groups involved are also involved in a lawsuit filed last November to curtail an ongoing government investigation of how teaching hospitals and their faculty physicians bill Medicare for the work of medical residents (Nov. 3, 1997, p. 4).
The 2-year-old investigation so far has netted $42 million in settlements. It's been expanded into a wide-ranging probe of the Medicare billing practices of teaching hospitals.
Individual members of the new coalition also have their own fraud efforts under way.
For example, the AHA hopes to announce as early as this week a legislative sponsor for an association-developed bill that would reduce the government's use of the False Claims Act to investigate hospital billing activities.
Meanwhile, some coalition members privately have expressed reservations about belonging to a group in which the lead organization has faced past fraud charges and might merely be trying to improve its image.
SmithKline Beecham, which has hosted the groups' meetings, paid the government $325 million last year to settle allegations of Medicare billing fraud (March 3, 1997, p. 28). SmithKline also paid the government $1.5 million in 1989 to settle allegations of illegal Medicare kickbacks stemming from its management of three physician-owned laboratories in California.
At deadline, SmithKline executives had not returned calls for comment.