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ACP-ASIM Pressroom

ACP-ASIM Faults HHS on Fraud and Abuse Efforts

Physician Group Questions Real Extent of Waste and Fraud in Medicare Program

APRIL 1, 1999

(Washington, DC): The Department of Health and Human Services' Office of the Inspector General (OIG) has rebuffed offers to work constructively with physician groups to explore ways to deal with fraud and abuse problems in the Medicare program, charges a letter released April 1 by the American College of Physicians - American Society of Internal Medicine (ACP-ASIM).

The letter, sent by ACP-ASIM Executive Vice President Walter McDonald to HHS Inspector General June Gibbs Brown, notes the group's "deep dismay about the apparent unwillingness of your office to engage in a continued dialogue with us on the OIG's efforts to reduce fraud, waste and abuse."

To date, the actions of the OIG and other government officials implies that the billings of all physicians are suspect, says the letter, "despite the OIG's stated claim that it is not interested in prosecuting physicians for honest mistakes or difference of opinions."

Specifically, the letter points to the "Who Pays? You Pay" campaign recently launched by HHS in conjunction with the American Association of Retired Persons (AARP). That campaign, the letter insists, sends "the unfortunate message to elderly patients that their physicians are not to be trusted."

"In our opinion, the 1999 Financial Audit of the Health Care Financing Administration (HCFA) made questionable assertions about the extent of waste, fraud and abuse," the letter states. " We are concerned that the report labels one-level differences of opinion between a physician and the OIG's medical review staff as 'incorrect coding.' Our members believe that such examples might more appropriately be called legitimate differences of opinion over which code to use out of the thousands of codes in a highly complex coding system."

The letter also criticizes the OIG for one of its top officials' recent refusal to meet with the ACP-ASIM to discuss constructive ways physicians could work with the government to help address fraud and abuse issues. "Without a commitment from the OIG to meet us halfway," the letter concludes, "there is nothing that we can do or say to reduce the prevailing distrust that physicians have in the OIG's stated intentions."

The letter noted that ACP-ASIM has provided the Inspector General with a comprehensive paper that proposes ways that physicians and the government could work together to reduce waste, fraud, and abuse - without making honest physicians feel that they are at risk.

ACP-ASIM is the nation's largest medical specialty organization and the second largest physician group. Membership comprises more than 115,000 internal medicine physicians and medical students. Internists are the major providers of medical care to adults in America and treat more Medicare patients than any other medical specialist.

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[NOTE TO EDITORS: A copy of the ACP-ASIM letter to the OIG is available on-line; and a copy of the ACP-ASIM's paper "Reducing Waste, Fraud and Abuse Without Increasing the Hassle Factor for Physicians and Their Patients" is available here.]


Jack Pope, ACP-ASIM Washington Office, 202-261-4556

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