HHS' inspector general's office has decided to issue a model anti-fraud compliance plan for solo and small physician practices, with final guidelines expected as early as next summer.
Eighty organizations and individuals responded to the inspector general's Sept. 8 request for comments on whether the agency should issue guidelines for such a complex segment of the healthcare business (Sept. 20, p. 24).
The agency already has issued proposed or final guidelines on avoidance of Medicare overbilling for hospitals, clinical laboratories, durable medical equipment suppliers, hospices, home-health agencies, Medicare HMOs and third-party billing agents.
In its comments on the matter, the American Medical Association said it was "pleased that the inspector general is willing to recognize distinctions in physician practice settings."
However, the AMA said it has "serious reservations" about the impact compliance guidelines would have on small practices, arguing that doctors have too many demands on their time to worry about compliance.
"The vast majority of physicians are honest, hardworking professionals who, in the context of their demanding workload, generally do not consider compliance to be a patient-care issue," wrote E. Ratcliffe "Andy" Anderson Jr., the AMA's executive vice president.
Specialist groups each had their own concerns about the inevitable guidelines. For example, pediatricians, who rarely deal with Medicare, worried about the lack of information on how to define the problem of Medicaid fraud.
"It is unfair to expect small physician offices to establish their own compliance programs and be subjected to investigations if neither the states, regional HCFA offices nor HHS can agree on whether the overpayment problem exists, how prevalent it may be and how to measure it," Donald Cook, M.D., president of the American Academy of Pediatrics, wrote in the group's comments to the inspector general.
At least one hospital group, the Federation of American Health Systems, submitted detailed comments to the inspector general. The federation, which represents for-profit health systems, said its members were interested in the possibility of guidelines because many of them own or partner with physician practices.
"Physicians should be encouraged to be familiar with their hospital's compliance policies," Thomas Scully, the federation's president, wrote to the inspector general. "(The guidelines) might also encourage physicians to play active roles in the compliance programs of other providers, which, in turn, impact them."
A spokeswoman for the inspector general's office said draft guidelines are expected to be published in the Federal Register next spring. After that, interested parties will have another chance to comment before final guidelines are issued.