Bush on health fraud: Physicians hope for lighter touch

Health lawyers say little will change, but doctors want to see less heavy-handed tactics against those making inadvertent mistakes.

By Jane Cys, AMNews staff. Feb. 26, 2001.

Washington -- Will the Bush administration continue the government's crackdown on health care fraud and abuse? Most observers say it's too early to tell exactly what the new president will do, but physicians are hoping that some positive changes in tone are in the works.

"Under the previous administration, you were guilty until proven innocent," said Douglas D. Henley, MD, executive vice president of the American Academy of Family Physicians. "We would hope that under the new administration, you would be innocent until proven guilty."

During Clinton's tenure, key officials at the Depts. of Justice and Health and Human Services placed a heavy emphasis on enforcing the nation's fraud and abuse laws. Congress and the president also approved new tools and federal dollars to assist law enforcement officials with their efforts.

Government officials have claimed large victories as a result of the extra help. In 2000, for example, Justice reported that $840 million of the $1.5 billion it recovered from civil cases came from health care fraud lawsuits.

But the stepped-up enforcement effort in the 1990s angered many physicians and other providers, who said the government was using heavy-handed tactics and targeting those who made innocent errors.

"The criminalization of the practice of medicine is extremely regrettable," said Donald J. Palmisano, MD, an AMA board member and a lawyer.

Physician groups say the small number of physicians who do commit fraud should be punished. But they often argue that the majority of wrongful payments to doctors are the result not of fraud or abuse but of unintentional mistakes made because of confusing Medicare regulations. [...]