HCFA defends role in Medicare red tape

Agency responds to charges by lawyer Robert Charrow before a House Budget Committee task force examining federal health programs for waste, fraud and abuse.

By Jane Cys, amednews staff. July 3, 2000.

Washington -- Even health care lawyers occasionally run into trouble navigating the myriad laws and regulations that govern Medicare.

About a decade ago, Robert Charrow, a health care lawyer with the D.C.-based firm Crowell & Moring, was suspicious of the Medicare coverage information home health and hospice providers gave his dying father. He straightened out the situation after several hours researching the law, speaking with Health Care Financing Administration officials, and then giving the providers free legal advice.

"If I, as a health care lawyer, could not easily find the law, how can we expect our consumers or even providers to understand the law?" he asked.

Charrow shared his story in June with a House Budget Committee task force that is examining federal health programs for waste, fraud and abuse. A May hearing focused on the concerns of physicians and other health care providers.

HCFA got the chance to respond to criticism at the June hearing. Many Medicare regulations have roots in legislation, noted Robert Berenson, MD, director of HCFA's Center for Health Plans and Providers.

"Congress is frequently very prescriptive in telling us how to implement the legislative changes it makes to our programs," Dr. Berenson said. For example, the 1997 Balanced Budget Act required the agency to act on at least 335 provisions.

Implementing these provisions affected every sector of health care, Dr. Berenson said, creating dissatisfaction among providers. HCFA has been working on initiatives to improve its guidance and education of providers, he added.

"We all share the goals of minimizing Medicare regulations and maintaining and strengthening the program's efficiency and integrity," Dr. Berenson said. "I think we also all appreciate the challenges these sometimes conflicting goals can present."

Dr. Berenson also disputed a much-quoted figure from a 1998 Mayo Foundation study that found Medicare regulations total more than 110,000 pages.

He said 34,000 of those pages can be traced to the Federal Register, which is a daily government-issued document that publishes new regulations. Many of those pages, he said, are HCFA's responses to comments filed by trade groups or others -- not new regulations that providers must digest.

The task force hasn't yet decided on its next step, but a spokesman said lawmakers are weighing several actions, including whether to hold hearings in their districts on the issue.