Study finds consultants promote Medicare fraud

Senate Finance Committee Chairman Max Baucus, D-Mont., said Wednesday he is working with ranking member Charles Grassley, R-Iowa, on ways to "improve" legislation intended to give doctors and other healthcare providers more due process rights in disputes with Medicare officials.

Baucus' comments came at a hearing on a GAO investigation that uncovered cases where healthcare consultants advised ways providers could take advantage of Medicare and Medicaid through questionable billing techniques. Consultants also provided advice on improving physicians' cash flow by discriminating against patients with low-paying insurance plans by providing them only with inconvenient appointment times.

Baucus said the legislation in question, known as the Medicare Education and Regulatory Fairness Act, "might, inadvertently, make it more difficult for the federal government to maintain the integrity of the Medicare trust funds."

At the hearing, GAO investigators played tapes from conversations with consultants at seminars, including one who said physicians often lose money because "the scheduler is too busy to think. Where that person simply has time to say 'OK, I'll work you in here or there,' and does not think about the fact that maybe we ought to be rationing certain of the lower-paid patients. Maybe we ought to tell some of the higher paid patients to come right on in ... and by the way, I'm not talking about real discrimination, I'm talking about somewhat discrimination."

Other conversations encouraged physicians who discover overbilling mistakes in their favor not to report them, because "there's no redder flag than that," and to use nurses and other paraprofessionals to perform services that the physician later charges for him or herself.

"This behavior is unethical, it can be illegal, and it's certainly intolerable," said Grassley, who originally launched the investigation last year when he chaired the Aging Committee.

Assistant Health and Human Services Inspector General Lewis Morris told the committee his office is issuing a "special advisory bulletin" to providers warning them that "hiring a consultant does not relieve a provider of responsibility for ensuring the integrity of its dealing with the federal health care programs."

Morris said providers who hire consultants should be wary of those who claim that seminars are required in order for them to maintain their Medicare "provider numbers" or that their seminars are authorized by the inspector general's office or Medicare officials.