Medicare Compliance & Reimbursement

Haunted by late-night worries about being targeted in a Medicare fraud investigation?

If you're a physician, you're not alone. A recent study sponsored by the Medicare Payment Advisory Commission reveals that about a quarter of physicians are "extremely concerned" about fraud and abuse investigations, and another 45.6 percent are "very concerned" or "concerned."

That's having an impact on physicians' bottom line, suggests the study, which was conducted by the Project HOPE Center for Health Affairs. More than two thirds of all physicians have billed "more conservatively than they felt was warranted in order to minimize the possibility of being investigated for fraud and abuse," the study says. Four in 10 doctors downcoded occasionally, while another three in 10 did so routinely.

Moreover, about 8 percent of physicians limited their acceptance of new Medicare patients out of worries about the anti-fraud campaign.

Anxiety over fraud and abuse investigations seems to afflict physicians across the board, says the study, titled "2002 Survey of Physicians About the Medicare Program" (No. 03-1) and released in March 2003. Patterns of concern "did not vary significantly by physician specialty, urban/ rural location, income, age, or the amount of time spent with [fee for service] Medicare patients."

The study also maintains that physicians' "overall satisfaction with the practice of medicine has held steady since 1999." Key concerns doctors identified included reimbursement, billing paperwork and malpractice issues.

To see the report, go to www.medpac.gov/publications/other_reports/Mar03_02tempPhysSurvRpt.pdf.

Lesson Learned: The more you know about Medicare compliance, the more likely you'll be to avoid both the perils of attracting investigators and the pitfalls of losing reimbursement you deserve.