Medicare fraud exists, some doctors are among those guilty of committing it and their offenses should not be tolerated. But there are also documented instances of physicians who can make a strong case that they have been unjustly caught up in overzealous audits. In recent years, the number of audits has increased. That's thanks to funding provisions built into the Health Insurance Portability and Accountability Act of 1996 and intense pressure from Capitol Hill to wring out waste, abuse and fraud from Medicare payments. Medicare carriers that perform the audits are sensitive to that pressure and have been aggressive.
Physicians have the right to be nervous.
The AMA has worked continuously to bring physician concerns to officials of the Heath Care Financing Administration, and to have them understand that Medicare's overwhelming complexity is a primary factor in incorrect billing. There are some signs that senior HCFA officials are listening, but progress has been slow and much more needs to be done. The AMA also is eyeing legislative reforms. For example, the AMA is strongly advocating that extrapolation of repayments not be used in first postpayment audits. Those audits should be used to educate physicians about their billing practices.