ACP-ASIM, OIG Discuss Ways to Address Internists' Concerns About Fraud and Abuse Campaign
June 2, 1999
Both Sides Recognize Potential Benefits of Closer Communication, Collaboration
(Washington, DC): A delegation from the American College of Physicians - American Society of Internal Medicine (ACP-ASIM) recently held a "cordial and productive" meeting with June Gibbs Brown, Inspector General of the Department of Health and Human Services, to discuss issues related to the OIG's fraud and abuse campaign, according to the ACP-ASIM participants.
The meeting was the result of an invitation by the Inspector General to discuss concerns raised in a previous exchange of letters between ACP-ASIM and the OIG. President Whitney W. Addington, MD, FACP, Board of Regents Chair David J. Gullen, MD, FACP, and Regent Cecil Wilson, MD, FACP, led the ACP-ASIM group.
The May 26 meeting between Inspector General Brown, her senior staff and the ACP-ASIM delegation focused on the gap between internists' perception of the OIG's enforcement actions and how the OIG itself characterizes them. The ACP-ASIM representatives explained why many internists felt that the "Who Pays, You Pay" campaign-which urged Medicare beneficiaries to scrutinize bills from physician—would cause patients to lose trust in their physicians. They also noted that the OIG's estimates of "improper payments," which typically involve coding discrepancies or inadequate documentation, have led to increasingly intrusive Medicare carrier review policies.
The OIG observed that concerns about "overzealous prosecution" are not supported by the very few physicians who have actually been targeted for a fraud and abuse investigation by their office.
Also discussed at the meeting were ways in which ACP-ASIM and the OIG might work together to provide input into OIG's initiatives affecting internists. Both the OIG and ACP-ASIM recognized the potential benefit of working together in developing future OIG initiatives that would directly affect internists and their patients. ACP-ASIM cited several examples of initiatives where closer consultation might prove to be productive including the OIG's 1999 work plan on reviewing coding for physicians' evaluation and management services, advance discussion of findings in the OIG's chief financial officer (CFO) audit of HCFA relating to improper coding and documentation by internists and other physicians, and educating internists and their patients on fraud and abuse.
"I believe that this meeting represented an important 'first step' toward moving away from an adversarial relationship between internists and the OIG to one where we can work together on the shared goal of eliminating fraud and abuse," said Alan Nelson, MD, FACP, executive vice president of ACP-ASIM and a member of the delegation. "The next step will be to explore specific opportunities with the OIG where more dialogue with ACP-ASIM might improve the effectiveness of the OIG's enforcement activities-in a way that won't create more undue anxiety and hassles for honest internists and their patients."
At the meeting, the internists provided OIG with ACP-ASIM's recently published compliance guide, "What Internists Need To Know About Compliance Requirements of Federal Health Programs." The publication describes the differences between fraud, abuse, and "improper payments" as well as how to avoid an OIG or Medicare carrier audit. The compliance requirement publication (product number 410703580) is available free to members and at a nominal price to non-members from the College's customer service department at 1-800-523-1546 ext. 2600.
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.
Jack Pope (202) 261-4556
Page updated: 11-04-03