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Am Fam Physician. 1998;58(4):839-840

Inspector General Reassures Physician Community About Billing Errors

Health care professionals will not be subject to the civil monetary penalty laws or the False Claims Act for billing errors, honest mistakes or negligence, according to June Gibbs Brown, inspector general of the Department of Health and Human Services. In a letter sent in August to the American Academy of Family Physicians (AAFP) and other physician organizations, Brown cites Attorney General Janet Reno's statement in February that it is not the policy of the Department of Justice, “to punish honest billing mistakes, nor do we prosecute doctors or hospitals for mere negligence.” According to Brown, “our law enforcement efforts are focused on improper claims that are made intentionally, or with reckless disregard for the truth or with deliberate ignorance of the truth.” Brown further states that, “In almost all cases, reckless disregard or intentional filing of false claims is proved by establishing a pattern of conduct. For criminal penalties, the standard is even higher—the intent to defraud must be proved beyond a reasonable doubt. On the other hand, it is important to note that all health care providers have a duty to reasonably ensure that the claims submitted to Medicare and other federal health care programs are true and accurate.”

The Outlook for Tobacco Control Is Shifting to the States

With the apparent failure of the 105th Congress to enact legislation to reduce the access of tobacco products to youth and to confirm the authority of the U.S. Food and Drug Administration to regulate tobacco, the scene is shifting to the states. Attorneys general in Mississippi, Florida, Texas and Minnesota already have negotiated comprehensive settlements with the tobacco industry, winning a total of $36 billion to compensate for state costs in caring for victims of tobacco. Now attorneys general from Washington, California, Colorado, Massachusetts, New York, North Carolina, North Dakota, Oklahoma and Pennsylvania have begun discussions with the tobacco companies to see if a settlement can be reached without reference to federal issues. In addition, Washington state's lawsuit against the tobacco industry was scheduled for trial in Seattle on September 14.

105th Congress Nears Completion

Members of Congress hope to adjourn by October 9 to return home and campaign for the upcoming November elections. Among the remaining health issues under consideration are managed care and appropriations for the Department of Health and Human Services. In the House of Representatives, a managed care bill has passed that includes the prohibition of gag clauses, allows direct access to obstetricians/gynecologists, requires internal and external appeals processes, enables patients to be reimbursed for care in the emergency department if a prudent layperson standard is met and requires better consumer information about the plan. In the Senate, a Republican task force chaired by Sen. Don Nickles (R-Okla.) is recommending similar provisions—but for employer self-insured plans only—in its Patient's Bill of Rights Act (S 2330). Meanwhile, the House Appropriations Committee has reported out a bill that includes increased FY 1999 support for health professions training programs, including an increase for family medicine training over last year (from $49 million to $51 million). Funding for the Agency for Health Care Policy and Research, the federal home of primary care research, would be just over $171 million, an increase of $24.5 million from last year.

Representative Ganske Resigns from Medicare Bipartisan Commission

In July, Rep. Greg Ganske (R-Iowa), a plastic surgeon, resigned from the National Bipartisan Commission on the Future of Medicare. Representative Ganske, one of the influential physicians currently serving in Congress, broke party lines to side with Democrats in favor of strong patient protection legislation. Representative Ganske was replaced on the commission by Colleen Conway-Welch, a professor and dean at the Vanderbilt University School of Nursing. Conway-Welch, a certified nurse midwife, also serves as a member of the National Advisory Committee to the Agency for Health Care Policy and Research. She was appointed to the Medicare Commission by House Speaker Newt Gingrich (R-Ga.).

AAFP Members Are Invited to State Legislative Conference

For the past few years, the AAFP has held an annual State Legislative Conference. The conference brings together representatives of the constituent chapters to discuss state legislative issues that are important to family medicine. Now that the conference is well established, efforts are being made to include other AAFP members, not just those designated by the state chapters. This year's conference, which will be held in Hilton Head, S.C., November 13–15, will feature AAFP Executive Vice President Robert Graham, M.D., discussing the current state of family medicine; journalist Peter Harkness, discussing the outcomes of state elections; and Matthew Myers, executive vice president of the Campaign for Tobacco-Free Kids and leader of the unsuccessful fight for tobacco control legislation this year, who will discuss the outlook for state tobacco settlements. Other sessions will focus on state scope of practice and managed care legislative issues. To obtain more information about the conference, call Fay Fulton, AAFP State Legislative Issues Manager at 888-794-7481.

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Copyright © 1998 by the American Academy of Family Physicians.

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