HHS: Says Disclosure of Misconduct May Lessen Penalties
Health care providers that promptly inform the government of improper conduct in federal health programs may receive "favorable treatment" in the resolution of their cases, including less strict corporate integrity agreements, according to an open letter to the industry issued yesterday by HHS Inspector General June Gibbs Brown. Corporate integrity agreements normally include a provision to exclude a provider from federal health programs if the provider violates the agreement, but Brown stated in her letter that the OIG may forego the exclusion clause -- or may not require a corporate integrity agreement at all -- in cases where the offending provider has shown "sufficient trustworthiness" and agreed to maintain a compliance program of proven effectiveness. In addition, the OIG may consider alternatives to standard auditing requirements or narrow the scope of claims reviews for self-disclosing providers (HHS release, 3/9).
Improper Medicare Payments Rise
Meanwhile, despite a much-publicized government crackdown on fraud in federal health programs, improper Medicare payments to providers increased slightly in 1999 to $13.5 billion, after declining significantly in 1997 and 1998, Brown said yesterday. Noting that the government had addressed many of the "easier problems" in its campaign against Medicare fraud, waste and abuse, Brown told the Senate Appropriations Committee that further reduction of improper payments would require "intensive work," including better documentation of claims by providers and more aggressive collection of debts by Medicare officials. Fraud appeared to account for only a "small proportion" of improper payments, although the government's audit focused only on billing mistakes, not on fraudulent activity, such as forged medical records, that could be used to justify inappropriate treatments, Brown added. The study did not examine payments to health plans, and Brown said the OMB had rejected her request for $15 million to hire federal auditors to work in the offices of insurers that handle Medicare claims (Pear, New York Times, 3/10).