American College of Physicians: Internal Medicine — Doctors for Adults ®

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OIG agrees to meet with College to discuss fraud and abuse efforts

From the May 1999 ACP-ASIM Observer, copyright © 1999 by the American College of Physicians-American Society of Internal Medicine.

After protests from the College, the Department of Health and Human Services' (HHS) Office of the Inspector General (OIG) has offered to meet College representatives to discuss efforts to reduce Medicare fraud and abuse.

In an April 1 letter to HHS Inspector General June Gibbs Brown, the College complained that the OIG was refusing to participate in a dialogue with ACP-ASIM. The letter, signed by ACP-ASIM Executive Vice President Walter J. McDonald, FACP, stated that internists have become increasingly concerned about the OIG's intentions.

Earlier this year, OIG's chief counsel D. McCarty Thornton told ACP-ASIM's Medical Services Committee that his office "is not interested in prosecuting physicians for honest mistakes or difference of opinions." Dr. McDonald's letter pointed out that since that time, HCFA introduced the "Who Pays? You Pay" campaign, which asks Medicare beneficiaries to be on the alert for fraudulent activities by physicians and other health care providers. The College's letter complained that the campaign sends the "unfortunate message to elderly patients that their physicians are not to be trusted."

College officials complained that since the campaign began, OIG's chief counsel D. McCarty Thornton has declined to meet with ACP-ASIM to discuss how physicians can help the government address fraud and abuse issues.

A recent letter from the OIG said that Ms. Brown and her staff welcome the opportunity to meet with College staff to discuss fraud and abuse efforts and pointed out that the OIG accepted the College's invitation to meet two out of three times. The letter defended the "Who Pays? You Pay" campaign by saying that Medicare beneficiaries are capable of detecting certain kinds of improper charges by carefully examining their explanation of medical benefit documents.

In its original letter, ACP-ASIM also pointed out that a recent audit of HCFA by the HHS Inspector general found "questionable assertions about the extent of waste, fraud and abuse," raising concern that one-level differences of opinion between a physician and the OIG's medical review are being considered fraud.

The full text of the is available in the "Where We Stand" section of ACP-ASIM Online.

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