News in brief - Dec. 8, 2003

Federal government netted nearly $2 billion in fraud settlements - FTC says MGMA survey isn't price-fixing - Global AIDS funding in foreign aid package

Federal government netted nearly $2 billion in fraud settlements

Health care fraud judgments, settlements and administrative impositions resulted in more than $1.8 billion in recoveries for the federal government during fiscal year 2002, according to the Dept. of Justice. The government actually collected more than $1.6 billion during the fiscal year from these actions, as well as actions in prior years that are still being collected. About $1.4 billion of that went to the Medicare Trust Fund.

Among the largest recoveries last year was $641 million from hospital chain HCA Inc. to settle charges of cost report fraud, kickbacks to physicians and Medicare overbilling for services at wound care centers. Another was $280 million from AstraZeneca Pharmaceuticals LP to settle allegations that the company conspired with health care professionals to charge Medicare, Medicaid and other government programs for free samples of the prostate cancer drug Zoladex.

FTC says MGMA survey isn't price-fixing

The Federal Trade Commission in November said it doesn't foresee problems with the Medical Group Management Assn.'s plan to ask physicians about their relationships with health insurers -- including payment information -- and then publish the results.

The MGMA was concerned that the FTC would view its effort as price-fixing, which would violate federal laws that don't allow competing physicians to share such data. But a letter from the FTC's Bureau of Competition stated that certain safeguards in place would prevent problems. Those safeguards include focusing on past or current payments, rather than future payments; publishing statistics that combine data from at least five respondents; and publishing the information in aggregate form so that prices that individual insurers pay or money that individual physicians receive can't be seen.

MGMA plans to survey Colorado family physicians, internists, pediatricians and obstetrician-gynecologists first. If the group is successful, it then may expand into other states and specialties.

Global AIDS funding in foreign aid package

The final version of a foreign aid package agreed to by congressional negotiators includes $2.4 billion in funding for global AIDS, tuberculosis and malaria programs. The Bush administration had asked for $2 billion as a first-year down payment on a vow to give $15 billion over the next five years. It argued that the programs would not be able to use a full $3 billion in their startup year.

Some of the additional money came at the expense of Bush's Millennium Challenge Account, which is meant to encourage developing countries to embrace democratic governance, human rights and capitalist markets.