HOSPITALS: Bill Would Protect Industry From Probes
"Hurt by a series of investigations and large penalties under a federal fraud statute, the hospital industry is waging a battle on Capitol Hill to make it more difficult for prosecutors to bring such cases against health care providers," the New York Times reports. Congress is reportedly considering a bill "that would create exemptions and special considerations for providers under the False Claims Act." Hospital industry officials and members of Congress "said that changes were needed to insure that hospitals were not sanctioned for innocent mistakes that resulted from vague and poorly worded billing rules." Rep. Bill McCollum (R-FL) is sponsoring a bill that "calls for raising the standard a jury must use to determine whether a civil violation has been committed by a health care provider." Additionally, McCollum's bill would restrict government prosecution in cases where "the amount of money in question is less than certain minimal levels or the provider" could cite government records supporting billing decisions. McCollum said, "We have had very reliable and accurate reports of cases where assistant United States attorneys have been blackmailing providers into situations where they can't resist but settle."
Federal law enforcement officials criticize McCollum's legislation, saying it would "derail their ability to bring civil cases against providers." Noting the McCollum bill's retroactivity, officials said their investigation into Columbia/HCA Healthcare Corp.'s billing practices could be affected. Further, the Times reports that McCollum's proposals "could also preclude so-called quality cases," under which the government claims that "federal programs were cheated" by providers that delivered sub-standard care. Prosecutors also note that the "haphazard" nature of the "federal health care system" makes it easy for providers "to point to some directive that would support their billing decisions." In such cases, federal officials point out that the McCollum proposal would prevent prosecution. Sen. Charles Grassley (R-IA) defended current federal law, saying McCollum's proposal "is a misguided missile in the war against fraud." He said current law is "good" and that he is "not going to stand by and let it be gutted."
More Back And Forth
Deputy Attorney General Eric Holder Jr. maintained that hospital industry concerns about arbitrary federal prosecutions "just aren't real ones." Other law enforcement officials "said that in instances where the [False Claims Act] was inappropriately applied the hospitals needed only to speak with prosecutors and provide information in support of their claim." Hospital officials, however, "said that until they began to apply political pressure the Justice Department did not seem eager to listen." American Hospital Association Executive Vice President Rick Pollack said, "It wasn't until recently, when they saw Congress was sensitized to the issue, that they became interested in talking to us" (Eichenwald, 3/31).