March 19, 1999

APA is concerned that the federal government's well-intentioned initiative to uncover fraud and abuse in the Medicare program may have unforeseen negative consequences for psychiatrists and their patients.

The program received an official kickoff on February 24, when the Clinton Administration and the American Association of Retired Persons (AARP) held a joint Washington, D.C., press conference with satellite hookups to about two dozen other cities.

The thrust of the White House and AARP effort, which the administration is calling "Who Pays? You Pay," is to encourage Medicare beneficiaries to examine every physician and other Medicare service bill in detail and then to contact the doctor or other provider if they question any of the charges.

If beneficiaries are not satisfied with their physician's response, the new campaign urges them to then take up the matter with the Medicare insurance carrier and, if still troubled, to alert the inspector general's office in the Department of Health and Human Services (HHS) through a hotline at (800) HHS-TIPS.

President Clinton issued a statement to coincide with the campaign's kickoff that describes it as "another step toward ending the fraudulent practices that rob taxpayers and threaten the future of the Medicare trust fund."

He said that in addition to teaching beneficiaries how to identify incorrect billing, the administration "will continue to work with those in the provider community who are equally committed to eliminating health care fraud."

Clinton added that since he ordered the stepped-up effort to detect fraud and abuse in 1993, health care fraud convictions have increased by 240 percent and saved taxpayers more than $38 billion.

APA, in a position shared by the American Medical Association, is concerned that the administration is using unnecessarily inflammatory rhetoric to inform citizens that fraud and abuse do occur in the Medicare program and in not being explicit enough in explaining that most physician billing errors are inadvertent.

The government appears to be trying to turn Medicare beneficiaries into "fraud busters," observed Nicholas Meyers, deputy director for congressional relations in APA's Division of Government Relations. This tactic has the potential to compromise seriously the trust between psychiatrists and patients with "needless antipathy and a climate of automatic suspicion of wrongdoing," he said.

APA certainly does not condone any attempts to defraud the Medicare program, Meyers noted, but believes the Clinton administration's program will add confusion and an adversarial component to the doctor-patient relationship.

APA also wants to alert its members to anecdotal evidence pointing to a recent increase in the number of claims for psychiatric care that Medicare insurance carriers are choosing to scrutinize.

The federal government is also targeting some mental health services for heightened enforcement efforts, particularly partial hospitalization services. The HHS inspector general is looking especially hard for inappropriate billing by partial hospital programs (and not solely for psychiatric care) of recent vintage run by community mental health centers.

Because the heightened enforcement scrutiny is occurring at the same time as the campaign to encourage the public to search their Medicare bills for possible fraud, APA is very concerned that the result will be "additional unintended hassles for our members," said Jay Cutler, J.D., director of the APA Division of Government Relations.

APA has included two sets of "talking points" in the "Public Policy Advocacy" section of its Web site, one for physicians to use in discussing the Medicare fraud effort with patients and one for district branches and medical societies in talking with lawmakers or federal officials. To access these talking points, refer to the Web address box on page 3.