Government gets tough on abuse
Sidestep that encircling net
You should be aware of anti-fraud legislation that’s coming down the pike because your name is virtually on it. Here are highlights applicable to your job of the "Medicare/Medicaid Anti-Waste, Fraud and Abuse Act of 1997" and recommendations included in the budget bill signed by the president on Aug. 5:
• Bars all kickbacks to doctors for referring patients to specialists. This is an expansion of existing laws.
• Establishes a national program for collecting data. The federal government has not carried out laws passed in 1996 and 1987 that were designed to exclude unscrupulous doctors from Medicare, Medicaid, and other federally funded health care programs. The 1996 law required the Secretary of Health and Human Services to establish a data collection program for the reporting of final adverse actions against health care providers. In announcing the push to find fraud, President Clinton said the administration would act quickly to create the database.
• Requires doctors and institutions to provide a Social Security number. This would close a major loophole that allows institutions to participate in Medicare and Medicaid by changing the names of their businesses after being expelled.
• Makes it more difficult to avoid penalties by declaring bankruptcy. The Clinton administration sees this as another loophole that allows institutions to skip out on their fines and penalties by declaring bankruptcy, then open a business under another name.
• Attaches a lasting stigma to expulsion from Medicare or Medicaid. Hospitals and other organizations would be barred from hiring anyone who has been expelled from the federal health care programs for misconduct until that person has been reinstated. Health care providers would be expelled for a minimum of six months, and reinstatement would not be possible until they corrected the problems that led to the expulsion.
• Expels health care providers convicted of felonies. Expulsion would be possible even if the felony had nothing to do with health care.
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