AMA, others sue federal inspectors over audits
The tables are turned now that federal inspectors are facing a lawsuit alleging that they have been unfairly targeting teaching hospitals in search of fraudulent overbilling. The American Medical Association and the Association of American Medical Colleges are joined by 19 other plaintiffs in the lawsuit, including the University of California (UC) system, which has been accused of overbilling the government for millions of dollars. The lawsuit contends that the federal inspectors are penalizing teaching hospitals for supposed billing errors by using standards enacted in 1996, whereas the procedures were performed and billed between 1990 and 1995.
Billing rules in effect at that time were inconsistent and vague, the lawsuit contends, especially concerning whether the physician had to be present to bill for services. The audits are part of the Physicians at Teaching Hospitals (PATH) program orchestrated by the U.S. Health Care Financing Administration. The PATH program was prompted in part by the infamous Medicare fraud investigation at the University of Pennsylvania in Philadel-phia, which resulted in a $30 million settlement with the federal government.
UC officials have stated repeatedly that they are cooperating with the government investigation even though they also are suing the inspectors. UC medical centers have not been audited yet, but inspectors have asked for preliminary data from the system’s five medical schools.
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content