Medicare fraud: Back to stricter scrutiny?

The government swings from collaboration and education to punishment and sanctions. Physicians are concerned that the pendulum is swaying back toward enforcement at all costs.

By Markian Hawryluk, AMNews staff. March 3, 2003.

The federal government's approach to health care fraud enforcement fluctuates between two philosophies. One favors throw-the-book-at-them tactics. The other wants to use the proverbial book as an educational tool.

In the waning days of the Clinton administration, and particularly with the arrival of Janet Rehnquist as the Health and Human Services' inspector general in the Bush administration, the attitude shifted more toward education.

Federal investigators still vigorously pursued outright cases of fraud by physicians and other practitioners. But program integrity guardians shifted resources toward outreach and placed a greater emphasis on compliance programs and clearer iterations of the rules to help physicians avoid billing mistakes that might be mistaken for fraud.

Now that may be changing. There is a growing voice among federal lawmakers that it is time to toughen anti-fraud measures. That could mean a return to a time when fear of prosecution reigned supreme. It could also cause further discontent among physicians already unhappy with the Medicare program.

In the late 1990s, few health care issues were as big as fraud and abuse. With high-profile cases, such as the Columbia/HCA Healthcare investigations, the subject dominated not only public policy discussions but the evening news.

"It was really great to be involved in an industry where you could turn on the TV almost any night, turn to the national news, and see somebody you knew walking out of their office in handcuffs," said Joseph Antos, a health policy expert with the American Enterprise Institute.