The U.S. government, not hospitals, is to blame for Medicare overpayments because of unclear and sometimes conflicting guidance on claims, according to a report released last week by the American Hospital Association.
Meanwhile, the first opposition to an AHA-backed bill that would make it harder for the government to use the federal False Claims Act against hospitals has surfaced in Congress. The bill is sponsored in the House by Reps. Bill McCollum (R-Fla.) and William Delahunt (D-Mass.). No companion bill has been introduced in the Senate.
The bill establishes new "safe harbors" for hospitals and sets a threshold of damages before a False Claims Act action can be brought (April 20, p. 90).
Sen. Charles Grassley (R-Iowa) and Rep. Fortney "Pete" Stark (D-Calif.) were scheduled to hold a press conference April 27 to attack the bill as an unnecessary weakening of federal anti-fraud tools. The False Claims Act allows the federal government to charge triple penalties in fraud cases.
"This is like the tobacco companies asking for immunity from prosecution," Stark said. "What the AHA wants is to get hospital administrators who have committed crimes off the hook."
Grassley said: "If this bill passes, perpetrators of fraud will be celebrating in the streets. This bill is a misguided missile in the war against fraud."
The AHA launched its own attack last week. In a report prepared by the law firm of Jones, Day, Reavis & Pogue, the AHA said the U.S. Justice Department has pursued hospitals for fraud and overpayment relating to "unbundling" lab test charges even though there are no regulations or laws that require bundling.
"The Justice Department has willingly and knowingly pursued prosecution of hospitals based on no laws, no regulations and conflicting government instructions to hospitals," AHA President Richard Davidson said at a press briefing unveiling the report. "Clearly this is nothing more than a collection effort."
The report also said that a number of Medicare fiscal intermediaries had told hospitals that if they submitted claims for lab tests separately, the intermediary would bundle the tests into one payment.
Last year, a federal judge in Cincinnati dismissed a lawsuit filed by the AHA and the Ohio Hospital Association trying to stop use of the False Claims Act relating to the federal lab unbundling investigation under way in 15 states. The AHA and the OHA appealed the judge's ruling in February. The appeal is still pending.
Also last week, Justice Department officials briefed Senate staffers on the hospital fraud situation. According to one GOP aide who attended the briefing, the Justice Department made few concessions.
"I don't think there will be any reduction in the enthusiasm with which they pursue investigations," the staffer said.
