Federal Officials Offer Warning On Medicare Billing Abuses

Health and Human Services Secretary Kathleen Sebelius and Attorney General Eric Holder notified hospital trade groups Monday that they planned to prosecute providers that use electronic records to "game the system" by billing Medicare for more complicated care than they actually deliver.

The New York Times: U.S. Warning to Hospitals on Medicare Bill Abuses
Saying there are "troubling indications" of abuse in the way hospitals use electronic records to bill for Medicare and Medicaid reimbursement, the Obama administration warned on Monday that it would not tolerate what it called attempts to "game the system" and vowed to vigorously prosecute doctors and hospitals implicated in fraud (Abelson and Creswell, 9/24).

Center For Public Integrity: Cabinet Officials Signal Crackdown On Medicare Billing Abuse
Top federal officials are stepping up scrutiny for doctors and hospitals that may be cheating Medicare by using electronic health records to improperly bill the health plan for more complex and costly services than they deliver. U.S. Health and Human Services Secretary Kathleen Sebelius and Attorney General Eric Holder notified five medical groups of their intention to ramp up investigative oversight, including possible criminal prosecutions, by letter on Monday (Schulte, 9/24).

Reuters: U.S. Warns Hospitals Against Medicare Scams, Vows To Prosecute
There are "troubling indications" some hospitals may be using electronic records to defraud Medicare, the Obama administration said on Monday, promising to prosecute any doctors and hospitals found "gaming the system". U.S. Health and Human Services Secretary Kathleen Sebelius and Attorney General Eric Holder warned five hospital-related interest groups of signs of abuse of the Medicare healthcare program administered by the federal government (Morgan, 9/24).

The Hill: Holder, Sebelius Warn Hospitals Against Fraud
The Obama administration warned hospitals Monday not to use electronic health records to illegally boost their Medicare payments. Attorney General Eric Holder and Health and Human Services Secretary Kathleen Sebelius laid out their concerns in a letter to hospital trade associations, including the American Hospital Association and the Federation of American Hospitals. Holder and Sebelius reiterated the administration's support for electronic records, which can help reduce errors and improve efficiency. "However, there are troubling indications that some providers are using this technology to game the system, possibly to obtain payments to which they are not entitled," they wrote. "False documentation of care is not just bad patient care; it's illegal" (Baker, 9/24).

Politico Pro: HHS Warns Hospitals On Upcoding
The Obama administration warned the nation's hospitals Monday against using electronic medical records to "game the system" to duplicate payments or "upcode" the severity of their patients' conditions for profit. "There are troubling indications that some providers are using [electronic medical records] technology to game the system, possibly to obtain payments to which they are not entitled," HHS Secretary Kathleen Sebelius and Attorney General Eric Holder told the nation's largest hospital trade groups in a letter. "Law enforcement will take appropriate steps to pursue health care providers who misuse electronic health records to bill for services never provided" (Haberkorn, 9/24).

National Journal: Obama Administration Warns Hospitals On Fraud
The Obama administration warned hospitals on Monday that the government would vigorously pursue cases of fraud involving the use of electronic medical records to inflate bills and generate extra revenue. In a sternly worded letter to several major hospital groups, Health and Human Services Secretary Kathleen Sebelius and Attorney General Eric Holder vowed to prosecute any abuses (McCarthy, 9/24).

Kaiser Health News posted a copy of the letter.

Meanwhile, in other news from the administration -

Politico: Medicare Advantage Bonuses Boost Plan Quality
The Obama administration will announce later this week that the quality of private Medicare plans is on the rise, thanks to an $8 billion demonstration project that pays them bonuses for good performance. And Republicans say that same project is covering up cuts to the popular program under the federal health care law (Norman, 9/25).

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