Magazine article Clinical Psychiatry News

McCarthyism in Medicine

Magazine article Clinical Psychiatry News

McCarthyism in Medicine

Article excerpt

LAWRENCE H. EINHORN

When Janet Reno was attorney general, she declared health care fraud to be public enemy number two, right behind murder but ahead of drug abuse. Three hundred new Federal Bureau of Investigation agents were hired to combat and rectify these irregularities. Medicare patients were encouraged to turn in their physicians if they suspected Medicare fraud and abuse, thus creating an environment akin to McCarthyism in medicine. I can envision a future in which physicians will appear before Congress and be asked, "Are you now or have you ever been guilty of incorrect coding and billing?"

Large fines have been levied and collected from academic medical centers and private institutions for failing audits by the Health Care Financing Administration. Our own institutions have compounded the problem by trying to exceed the HCFA guidelines. This has created a new cottage industry of compliance offices to ensure that coding and documentation are properly followed to avoid allegations of fraud and abuse. This has produced an unwieldy and unmanageable bureaucracy.

We are performing some components of history and physical examinations for the express purpose of documentation in order to be in compliance. We have hired increased transcription services to accommodate the lengthy dictations and notes that are now necessary. Indeed, we are sometimes spending as much time documenting care as providing care for our patients and their families.

Health care fraud and abuse have the potential to extract money illegally from the Medicare system and cannot be tolerated or condoned. However, my concern is that the government has overreacted. The current system has detracted from the time available for counseling grieving families; providing appropriate medical care; and teaching fellows, house staff, and medical students. Fellows learn as much about compliance as they do about certain types of cancer. …

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