Witnesses tell HCFA horror stories
As Congress ponders how to reform the Health Care Financing Administration, healthcare providers Wednesday brought their horror stories about dealing with the agency that administers Medicare to a joint hearing of two House Energy and Commerce subcommittees. David Becker, a gastroenterologist from Clearwater, Fla., told of a colleague who received a letter demanding a $66,960 refund of alleged Medicare over-payments. The physician paid, requested a hearing, and--during the interim--Medicare sent his patients letters informing them they were due a refund.
Ultimately, officials determined the physician actually owed only $600. Not only did it take 15 more months to refund the money--without interest--but "no letter was sent to [my] patients correcting the mistake Medicare had made…nor attempting to correct the damage done to [my] practice," Becker said.
Testifying on behalf of the Medical Group Management Association, Jyl Bradley--administrator of a Claremont, N.H., ambulatory surgical center--told of a rural clinic that struggled to return a mistaken overpayment of more than $1.2 million to its Medicare "fiscal intermediary." Even though the clinic did not deposit the checks, the insurance company began deducting from the clinic's other claims to make up the difference--deductions that continued even after the overpayment was successfully returned. "To date, [the] withholding has not ceased and [the Medicare contractor] now owes some $88,000 for services provided by the clinic," Bradley testified.
Subcommittee Republicans said the stories demonstrate just how dysfunctional the agency has become and warned that the increasing bureaucratic hassles are threatening to drive providers from the Medicare program, therefore jeopardizing beneficiaries' access to services.
Referring to HCFA testimony pointing out how the agency has improved its communications with healthcare providers, Rep. Richard Burr, R-N.C., said, "Clearly, that's not happening today." But Democrats said at least part of the problem is that Congress has simply given HCFA too much to do, and not enough resources to do it with. "It is somewhat unreasonable to ask HCFA to operate with a 2 percent administrative budget," said Rep. Bart Stupak, D-Mich. Although providers do worry about being punished for inadvertent errors, Michael Mangano of the HHS Inspector General's office testified, he added that most providers do understand Medicare's complex rules. "In the substantial majority of cases, legitimate providers are billing appropriately for Medicare covered services," he said. But he agreed that Medicare providers "need reassurances that they will not be assessed penalties for honest errors."