FP Report -- July 1999
Idaho FPs speak out against HCFA audits
BOISE, Idaho -- Catch the irony.
Idaho Falls FP Barry Bennett, M.D., right, told a compelling tale of a Medicare audit at the Idaho AFP's annual meeting May 14 in Boise. Afterward, many in attendance at the meeting had questions for fellow FPs and for representatives from the Health Care Financing Administration and the Medicare carrier CIGNA.Barry Bennett, M.D., an FP in Idaho Falls, had just about concluded 15 months of volunteer effort on a state medical association panel that was attempting to make Medicare doctors more accessible to patients. Then CIGNA -- Idaho's Medicare Part B carrier -- threw an audit his way.
Fifteen patient records and almost eight months later, Bennett and his partners were told they owed the Health Care Financing Administration almost $24,000 for overpayments. Between 65 and 70 percent of those funds, Bennett said, were attributed to hospital charts and nursing home records the physicians weren't even asked to submit in the first place.
"They specifically asked for 'office clinic notes,'" Bennett told more than 50 Idaho AFP members at a chapter panel discussion on audits May 14. "How they thought they'd get hospital charts and nursing home records out of clinic notes, I do not know."
Bennett and his partners jumped through several appeal hoops, managed to submit more relevant records to HCFA and saw the repayment request drop to about $7,000.
They also turned their backs on Medicare and now make their Medicare patients pay for treatment out-of-pocket, with the mutual understanding there is no option for reimbursement.
"I feel like I was hacked out of Medicare with an ax," Bennett said after the well-attended panel discussion concluded.
When CIGNA and HCFA panelists talked, they refused to comment on Bennett's issue directly.
But O. Dan Smith, M.D., of Idaho Falls, president-elect of the Idaho AFP, did comment. He faced an audit somewhat similar to Bennett's in recent months. He said he was penalized on records he could not locate quickly enough and therefore could not provide. The reason: Some nursing home records had gone down with defunct nursing home facilities, and some of these same records were stored in places as yet unknown.
Still, though, Smith told the crowd, he and his staff devoted about 350 hours to pulling together records.
"While we feel they did their job in the audit, the appeal I made at the end of the process is that I feel (HCFA) has done a lousy job of education," Smith said. "We attended all the seminars, trying to get things right and understand the process, and they still slapped us when I believe we were trying to do it right."
The audit uproar in Idaho is an alarming development, said Academy Board member David M. West, M.D., of Grand Junction, Colo.
Given these examples, West said, it's more important than ever for FPs to keep "scrupulous" medical records for Medicare.
"We all know that if someone's looking hard enough, and the rules are complex enough, they'll find mistakes," West said.
Another view: "First of all, this situation is not helpless," said family physician Stephen Gleason, D.O., of Des Moines, Iowa, who until recently led the Physician Regulatory Initiative Team at HCFA. "But second of all, it may seem that way for a bit longer."
Gleason, current director of the Iowa Department of Public Health, said that in Iowa alone, his recent efforts have revealed that the typical FP must devote 2,000 hours to learning about these HCFA-related regulations, and another 500 hours annually to keeping up with changes.
"The solution is to bring this to the attention of those who can make changes in a constructive way," he said. "I encourage doctors to take time out to talk to policy makers and make them aware of their concerns and difficulties."
According to Gleason, a grassroots effort like this is under way in Iowa, where even FPs and nurse practitioners are getting together to work toward change.
"This is not about practice," Gleason said, "this is about having the time to practice."
Check the following resources for help avoiding fraud/abuse charges:
- The Academy has scheduled a course at this year's Scientific Assembly in Orlando called "Controlling Medicare Fraud and Abuse: A View from the Inside" (No. 367) on Sept. 15, from 3:30 to 5:30 p.m. The cost is $50. As in the past, Assembly courses will be offered on evaluation and management documentation guidelines.
- Family Practice Management articles at www.aafp.org/fpm cover E/M guidelines as well as Medicare compliance programs.
- Academy members also can access www.aafp.org/fpassist/ for FP Assist, a network of consultants who can provide paid technical assistance in developing compliance plans.
By Todd Simchuk, Associate Editor
FP Report is published by the AAFP News Department. Copyright © 1999 by American Academy of Family Physicians.
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