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US doctors call for simpler Medicare rules

Fred Charatan, Florida

The American Medical Association and doctors groups representing different specialties are seeking relief from burdensome regulations that have resulted in many doctors refusing to accept new patients under Medicare, the healthcare programme for Americans aged over 65.

The doctors' drive comes at a time when the Bush administration and Congress are reviewing the Health Care Financing Administration and its management of Medicare. An annual audit of Medicare payments to doctors, hospitals, and other healthcare providers showed an error rate of 6.8% in the financial year 2000, representing an estimated $11.9bn (£8bn) in improper payments.

Two key committees of the US House of Representatives have begun hearings to review the administration's major programmes, policies, and operations. The House Energy and Commerce Committee recently wrote to Tommy Thompson, the secretary of the Department of Health and Human Services, protesting at the administration's complicated rules. It wrote: "Governed by an estimated 130000 pages of laws and regulations, many Medicare providers are spending as much time navigating their way through [the Health Care Financing Administration's] complicated regulatory process as they are on patient care."

The bipartisan Medicare Education and Regulatory Fairness Act of 2001 has been introduced into the House and Senate and incorporates many of the reforms sought by the American Medical Association and other doctors groups.

The bill includes the following main provisions:

• Doctors and healthcare providers will be subject to new regulations only when the secretary has promulgated final regulations

• Fiscal carriers (healthcare insurance companies such as Blue Cross that are under contract to Medicare and make reimbursements to doctors) cannot collect Medicare overpayments from doctors while the doctors are appealing against audit findings

• Medicare overpayments are to be recovered from doctors through a repayment plan or deductions from future reimbursements, except in cases of fraud

• Doctors will be able to remit overpayments they have mistakenly received within one year without the fear of being targeted for an investigation or audit, as long as the fiscal carrier or the government have not already begun to audit or investigate the doctor

(Credit: AP PHOTO/RON EDMONDS) President Bush discusses Medicare reform with members of Congress

• Funds will be reallocated from the budgets of fiscal carriers to education efforts for doctors.

• Doctors would also have the right to challenge the constitutionality of Department of Health regulations and would be permitted to appeal against the decisions of fiscal carriers to deny their Medicare enrolment applications or deny their re-enrolment in the programme.

• Democratic Representative Shelley Berkley of Nevada, one of the bill's sponsors said, "The bottom line is this: when doctors decide that it's too much trouble to deal with the Medicare system, they stop treating Medicare patients. It's simply too cumbersome to have to wade through all the government regulations."