As if last week's fraud report from the U.S. Justice Department wasn't scary enough, federal investigators want to double the number of provider Medicare audits they do, and they want providers to pay for it.
The Clinton administration plans to include 10 new anti-fraud initiatives in its fiscal 1999 budget, said HHS Secretary Donna Shalala. The budget is expected to be released Feb. 2.
Clinton mentioned the fraud initiatives in his Jan. 24 radio address.
In total, the 10 proposals would save Medicare about $2 billion over a five-year period starting Oct. 1. Congress must pass the plan before the initiatives could take effect.
For providers, the most onerous provision is likely to be one that would double the number of audits currently being done by HCFA. To pay for the increased audits, HCFA would charge audited providers.
A HCFA spokesman was unable to furnish the number of current annual audits.
"We are working on compliance plans that will include regular audits," said Richard Pollack, executive vice president for federal relations at the American Hospital Association. "Random audits, coming in and going through medical records, is incredibly expensive."
Another Clinton administration proposal would allow Medicare to pay the "best price" for drugs. Suppliers would be required to charge Medicare the lowest price charged any other customer.
Critics say such a proposal would lead to increased costs for all customers. When a similar law was passed for Medicaid several years ago, the General Accounting Office found that drug companies, unwilling to give such a large purchaser a major discount, increased the cost to other buyers.
Other Clinton administration recommendations include:
A nationwide competitive bidding program for durable medical equipment paid for by Medicare. Competitive bidding is believed to deter excess charges.
Allowing civil monetary penalties for physicians who falsely certify that a patient needs hospice care.
Expanding the "centers of excellence" program under which Medicare pays doctors and hospitals a flat fee to treat certain diagnoses.