Senate Will Hear Audiotapes of Doctors ‘Coached’ to Overbill

As part of a "crackdown on health care fraud," investigators from the General Accounting Office are looking at how some medical business consultants are "coaching doctors to boost income" by overcharging
the government and private insurers for some services. USA Today reports that the GAO's "[s]ecret audiotapes" of seminars between consultants and doctors held in the Washington, D.C. area since last July "provide a rare inside look at suspected tactics that investigators say might contribute to billions in improper claims." The audiotapes -- which will be played at a Senate hearing today -- reveal that consultants at the seminars offered "tips" on how to bill insurers for care "that was either not provided or was administered at lower cost by assistants"; how to restrict appointment times for low-income and elderly patients; and how to "[i]gnore federal rules" that require physicians to report Medicaid or Medicare overpayments (McCoy, USA Today, 6/27). For example, a consultant at one session advised physicians to schedule Medicare and Medicaid patients only for appointments between 10-11:30 a.m. and 2-3:30 p.m. so they would not occupy "the best appointment slots." Senate staffers declined to identify the consultants for legal reasons, but USA Today reports that it "independently learned" that such seminars were being offered by Conomikes Associates, which charges physicians about $250 for its workshops. Conomikes CEO George Conomikes says his company "has never coached doctors to use improper insurance billing techniques," adding, "Our role in workshops is not to tell you what to do but to tell you what we see happening (at doctors' practices) around the country, and then it's up to you" (McCoy, USA Today, 6/27).

The Senate Finance Committee will hold a hearing today on the fraud allegations. Finance Committee Chair Max Baucus (D-Mont.) and ranking member Charles Grassley (R-Iowa) are expected to ask HHS to investigate the companies that ran the seminars and examine the insurance records of doctors who attended in order to look for "billing violations." Grassley said, "I think it's outrageous that we would have people going around and showing health care providers how to bill for services that were never rendered." Federal health officials will likely issue a special advisory today "warn[ing]" doctors that filing false insurance claims can be punished by prosecution and fines (McCoy, USA Today, 6/27). Senate staff members and federal investigators say that a "virtual absence of regulations" governing medical business consultants has allowed the firms to conduct the seminars (McCoy, USA Today, 6/27).