Organized medicine leads the way to Medicare reform

AMA Leader Commentary. By Timothy T. Flaherty, MD Jan. 7, 2002.

AMA LEADER COMMENTARY

A few words about current events in medical practice

SEE ARCHIVES

A message to all physicians from Timothy T. Flaherty, MD, chair of the AMA Board of Trustees.

At the 2001 National Leadership Conference, the AMA and the Federation mounted an aggressive grassroots campaign to change how Medicare does business with physicians.

Today, less than a year later, important legislation designed to achieve this goal has been packaged and passed by the U.S. House of Representatives -- with a vote of 408-0.

The overwhelming support for HR 3391, the Medicare Regulatory and Contracting Reform Act of 2001, shows us yet again how much organized medicine can accomplish in Congress -- and how quickly -- when we speak with a united voice in support of legislation that is timely, necessary and good.

This legislation provides a way to end some of the worst abuses associated with postpayment Medicare audits -- and to give physicians who are being audited due process protections.

But what does this mean to your practice, you ask? Let's start with a real-life story.

A carrier audited a sample of 80 claims and determined that the physician in question had made billing errors. From that information, the carrier extrapolated to the other claims submitted by the physician -- and projected that Medicare had overpaid the physician by $99,000.

Without receiving any notice that there were problems with his billing, the physician was told to pay back the entire $99,000. Within 30 days.

The physician managed to make the payment, but he also filed an appeal. Three years later, after much legal wrangling, a judge ruled that the physician had not been overpaid at all -- and that the $99,000 he paid was indeed rightfully his. The physician finally got his money back. But with no interest. [...]