Federal investigators must try harder to ensure that data being used in hospital fraud investigations are accurate before notifying hospitals of potential violations, the General Accounting Office said in a report released last week.
Another report the GAO released last week addressed the government's ongoing investigation of how teaching hospitals and their faculty physicians bill Medicare (See story, this page).
The report calling for accurate data is good news for hospital groups that have battled investigators over the use of the federal False Claims Act for hospital billing cases.
"It's a very balanced report," said Mary Grealy, general counsel for the American Hospital Association, which has led the charge on limiting the use of the act in healthcare fraud investigations.
The hospitals say the Medicare rules are confusing and implemented unevenly by Medicare's fiscal intermediaries. The GAO agreed with those concerns and added that federal investigators should make a stronger effort to test the data it uses before contacting hospitals.
"HCFA and the fiscal intermediaries have the responsibility to issue clear, consistent and timely guidance," Grealy said.
However, the GAO also commended the U.S. Justice Department for responding to hospital industry concerns by issuing guidelines for its investigations. "The Department of Justice has recognized the legitimacy of these concerns and has developed guidance for using the False Claims Act in multistate initiatives and established working groups to improve coordination and development of cases," the report said.
The 20-page report was requested earlier this year by U.S. Reps. Bill Archer (R-Texas), Henry Hyde (R-Ill.) Lamar Smith (R-Texas) and William Thomas (R-Calif.).