A federal initiative to weed out Medicare fraud at teaching hospitals is going strong despite earlier setbacks and growing opposition from healthcare provider organizations.
After pulling back from audits at 16 of the nation's most prestigious training grounds for physicians, HHS' inspector general's office is pursuing "PATH" investigations at an estimated 50 institutions nationwide.
The Physicians at Teaching Hospitals, or PATH, initiative focuses on Medicare claims filed by the targeted hospitals and their faculty practice physicians between 1990 and 1995. The initial scope of the investigation was on how hospitals and physicians billed Medicare for the work of medical residents. It has since widened to include how the hospitals bill Medicare for care to beneficiaries.
Through the federal Freedom of Information Act, MODERN HEALTHCARE obtained a list of the 16 hospitals dropped from PATH (See box).
Under congressional and provider pressure to curb the investigation, HHS dropped the 16 audits last summer but declined to identify the hospitals (July 21, 1997, p. 12).
While these hospitals don't need to worry about PATH, they're not out of the woods entirely.
Some institutions have seized the opportunity to spruce up their compliance programs.
"There's no question it got our attention," Tim Goldfarb, director of Oregon Health Sciences University's healthcare system, said of the initial threat of a PATH probe. "There's nothing like a letter from the inspector general or from HCFA to focus your mind."
Oregon Health Sciences has created a new mechanism for employees to anonymously notify Goldfarb, who also is the system's compliance officer, of any potential billing irregularities.
In Massachusetts, nine teaching hospitals dropped from PATH still face inquiries from the U.S. attorney's office in Boston. Last October the hospitals received letters from the office demanding data similar to what PATH wanted.
In the past the Boston U.S. attorney's office has conducted investigations of Medicare billing problems independent of any national program being coordinated by HHS. In 1996, for example, it reached settlements with 83 Massachusetts hospitals for allegedly double billing Medicare for diagnostic tests performed within 72 hours of patient admissions.
The Massachusetts Hospital Association is a plaintiff in a lawsuit aimed at stopping the PATH audits as they now are being conducted (Nov. 3, 1997, p. 4). The other plaintiffs include the American Hospital Association, the American Medical Association and the Association of American Medical Colleges. Last Oct. 24 state and local medical associations joined the lawsuit. Later this month the AAMC expects to file a motion for a summary judgment in the case.