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Saturday, December 07, 2002Physicians are under a lot of growing financial pressures," said Peter Cunningham, who wrote the report for the Center for Studying Health System Change, a health policy think tank that conducts the ongoing survey of doctors. "This may be making it more difficult to serve uninsured patients." Its survey found that in 2001, 71.5 percent of doctors provided free care. That's down from 76.3 percent in 1997. The results are similar to those found by the American Medical Association, which also saw a drop in charity care between 1994 and 1999 in a survey it conducted of doctors. The result is less care for people who can't afford it. But, there’s another reason doctors don’t offer charity care. A lot of them assume they’ll be charged with fraud by the Medicare enforcers if they do: Secondly, Medicare may review your practice and decide that your billing of "insurance only" violates the "most favored nation" regulation they have whereby the Medicare fees must be the lowest you charge any patients. If you routinely accept "insurance only", you are telling the government that there is a fee schedule below what they are offered. In this case, Medicare may ban you from participation in Medicare and Medicaid, and can possibly investigate you under the False Claims Act. Some private insurance contracts have those “most favored nation” clauses, too. Doctors, or at least the people who advise them on Medicare laws, have taken the "charging insurance only" restriction and applied it to all discounts. No one wants to be accused of fraud. (There are hefty financial penalties for fraud, and sometimes jail time, too.) There’s some disagreement about this assumption, but the perception is widespread, nonetheless. My practice is owned by a hospital, and they’re very paranoid about this. Everyone has to be charged the same, no exceptions. They simply can’t risk being accused of fraud. They can’t risk the bad publicity nor the high legal costs of defending themselves against the accusation. It’s a lose-lose situation for them. SECOND THOUGHT: Could it be that my employers are just practicing Dilbert management? posted by Sydney on 12/07/2002 07:51:00 AM 0 comments 0 Comments: |
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