Organized medicine clearly is trying to come to grips with how to respond to the federal government's more vigorous anti-fraud activity. Recent actions by several leading physician groups suggest more are choosing cooperation over confrontation.
The nation's largest specialty group, the 115,000-member American College of Physicians-American Society of Internal Medicine, has established a working relationship with its former antagonists in HHS' inspector general's office.
The American Medical Association, meanwhile, has adopted a more defiant stance, asking its nearly 300,000 members to send their patients a form letter denouncing the government's complex requirements as "a disservice to you (the patient) and my other patients."
At the behest of its members, the ACP-ASIM has had a frank exchange with the inspector general about physicians' concerns-and is now working with the government to find solutions, said Robert Doherty, the group's senior vice president for governmental affairs and public policy.
The process started out acrimoniously, with an April 1 letter to Inspector General June Gibbs Brown from ACP-ASIM Executive Vice President Walter McDonald, M.D., blasting Brown's chief counsel for refusing an invitation to speak to the group's medical services committee about compliance issues.
In that letter, McDonald noted his "deep dismay" that Brown was not willing to continue the "candid but constructive exchange of views" that began at a January meeting where D. McCarty Thornton, chief counsel to the inspector general, addressed the ACP-ASIM.
"It was apparent that a single meeting would not be sufficient to resolve the wide differences of opinion over the government's intentions," McDonald wrote.
In a response dated April 13, Brown returned fire, stating that the ACP-ASIM's assertions were "unfounded and contrary to our objectives."
"If ACP-ASIM continues to believe that overzealous prosecutors are harassing honest doctors, it would be very useful for your organization to provide the basis for this assertion," Brown wrote. "When you produce this information, we can then have a meaningful dialogue regarding the validity of such assertions, which are being made with increasing frequency by physicians and physician groups."
Both sides met May 27, and the pow-wow was productive, the physicians said.
"It's a good case of both sides being right," the ACP-ASIM's Doherty said. "There aren't many physicians who are actually prosecuted, but the rhetoric has an effect. There's more scrutiny and second-guessing. We talked about how our members can handle that. We decided closer consulting at the outset could ease a lot of concerns about the inspector general's actions," he said.
But not all physician organizations believe the government is so approachable.
For example, the American Academy of Family Physicians has gone to beneficiaries with its concerns. After the government rolled out a campaign to have seniors become watchdogs of medical fraud, the AAFP leadership met with the American Association of Retired Persons to exchange views.
The AARP had joined HHS in sponsoring the "Who Pays? You Pay" campaign, which aims to teach seniors how to better read medical bills and report potential fraud.
"It's very difficult to overcome problems with the government because the government is in a well-defended position," said Robert Graham, M.D., executive vice president of the AAFP. "Plus, the (enforcement) agencies are under a great deal of pressure from Congress to save Medicare money. I really don't know what the best way to handle it is."
Graham described the AARP meeting as cordial but said the two sides did not reach any agreements.
The AMA is taking a two-pronged approach, appealing to beneficiaries as the AAFP has done and meeting with federal enforcers as the ACP-ASIM has done.
The cornerstone of the AMA's patient outreach is a form letter developed last month for its members to send to their patients.
The letter assures patients that the physicians are trying to comply with Medicare rules and warns them that inadvertent billing errors do occur occasionally. If patients notice any errors, they should contact the physician's office, the letter says.
AMA President Nancy Dickey, M.D., said communicating with patients about compliance efforts is especially important as more government money flows into educating seniors. Earlier this month, HHS Secretary Donna Shalala awarded $7 million in grants to fund "senior fraud patrols" in 38 states.
The AMA has also met with the inspector general's staff and HCFA.
"There are a number of areas where they've agreed to make changes, like giving physicians more time to respond to inquiries," Dickey said.
Like the ACP-ASIM, the AMA hopes to work out an arrangement whereby enforcement agents ask for physicians' advice on fraud alerts, reports and other initiatives.
"They continue not to call on us (for advice)," Dickey said. "We can certainly continue to use formal and informal means of communicating, but at some point we may have to pursue legislation or litigation."
Taking different roads doesn't mean that physician groups aren't all trying to end up in the same place, the ACP-ASIM's Doherty said.
"There is no conflict. Clearly, we all want to be constructive and eliminate real fraud and abuse," Doherty said."