Legitimate providers rarely make billing mistakes, HHS' Acting Inspector General Michael Mangano told members of Congress in defense of federal antifraud regulations.
Despite providers' charges that federal rules are too complex to follow, 93% of Medicare payments are free of error, Mangano said. That demonstrates "providers are doing a very good job of negotiating their way through Medicare rules and procedures," he said.
Nevertheless, the agency should better instruct providers about how to avoid running afoul of antifraud laws and should reduce confusion about the laws, Mangano said.
One possibility, he said, would be quarterly updates of new policies and interpretations of laws, as HHS Secretary Tommy Thompson has suggested.
Mangano spoke last week before a joint hearing of the House Energy and Commerce subcommittees on health and on oversight and investigations. The subcommittees are holding a series of hearings on restructuring HCFA to reduce providers' regulatory burden, speed beneficiaries' access to new treatments and improve quality of care.
Rep. Michael Bilirakis (R-Fla.), chairman of the health subcommittee, said providers often complain to him that HCFA's billing rules are difficult to understand. Contradicting Mangano, Bilirakis said, "There are many instances of honest providers, trying to make a living practicing medicine, who don't fully understand the coding process or specific rules and regulations that govern the Medicare program. Sometimes the honest mistakes cause undue suffering and hardship."
Meanwhile, Democrats argued that HCFA's $2.2 billion administrative budget would need an increase for the agency to fund better provider education efforts.