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Elderly recruited in fight against Medicare fraud; Government campaign violates doctor-patient trust, AMA leaders say


WASHINGTON -- The federal government will begin enlisting millions of Medicare beneficiaries in its war against Medicare fraud this week, urging them to report billing errors, overcharges and other evidence of possible wrongdoing by their own doctors and hospitals.

The campaign has strong support from lobbyists for the elderly, who see it as a way to educate consumers and save money for Medicare and its beneficiaries.

But the effort has provoked outrage among doctors, who say it will drive a wedge into the doctor-patient relationship, undermining the trust needed for effective medical care.

Federal officials will fan out across the country beginning Wednesday to show Medicare beneficiaries how to decipher their medical bills and find fraud.

The secretary of Health and Human Services, Donna E. Shalala, Attorney General Janet Reno and the director of the FBI, Louis J. Freeh, will speak to beneficiaries at 30 sites linked by satellite. The "fraud fighter rallies" will be held in Washington, New York City, Boston, Miami, Chicago, Dallas, Los Angeles, Seattle and Honolulu, among other places.

"Senior citizens are our first line of defense in the battle against Medicare fraud," Shalala said.

June Gibbs Brown, inspector general of the Department of Health and Human Services, estimates that improper Medicare payments totaled $12.6 billion last year. But she said she could not specify how much of this was attributable to fraud, as opposed to unintentional billing errors. Medicare finances health care for 39 million people who are elderly or disabled.

The theme of the new campaign is: "Who Pays? You Pay!" The message is that Medicare beneficiaries and taxpayers pay more when doctors, hospitals and other health care providers "rip off" the program, in the words of the Federal Health Care Financing Administration, which runs Medicare.

The government is offering rewards up to $1,000 for information that leads to the recovery of Medicare money lost to fraud and abuse. Federal officials said such abuse included billing Medicare for services that were never provided or were not medically necessary, billing for services more costly than those actually performed, and billing twice for the same service or supplies.

In recruiting "fraud busters," the government tells Medicare patients, "You can join the fight and help stop Medicare cheats from stealing your tax dollars."

Leaders of the American Medical Association met recently with Medicare officials to complain that the government was using inflammatory language that tends to set patients against doctors.

In a confidential report to AMA trustees, Dr. E. Ratcliffe Anderson Jr., executive vice president of the association, said: "We stated that we could not underscore strongly enough the outrage that physicians feel about these types of beneficiary outreach programs. We expressed physicians' grave concern that this type of rhetoric completely undermines the physician-patient relationship."

But federal officials said patients are often in the best position to spot fraud and abuse.

Medicare contractors say that they receive 130,000 telephone calls about potential fraud and abuse each year and that 72 percent, or 94,000 calls, are from beneficiaries, many of whom question the propriety of claims filed on their behalf.

The American Association of Retired Persons, a co-sponsor of the new campaign, says, "Medicare beneficiaries must become the eyes and ears of law enforcement."

The group is urging its members to join a "neighborhood fraud watch," which will scrutinize Medicare statements for questionable charges.

In brochures to be disseminated at the kickoff events next week, the AARP says: "Most health care providers are honest, and the questionable charge may be the result of a clerical error. That's why many people call their provider first.

"However, if you're not sure, you don't feel comfortable talking with your provider or your provider's answer is not satisfactory, don't hesitate to report a questionable charge to the Medicare fraud hot line at 1-800-447-8477."

Pub Date: 2/21/99

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