OIG to study physicians who leave Medicare

Federal officials express concern about whether specific areas of the country are seeing higher numbers of doctors opting out.

By Charles Fiegl — Posted Oct. 13, 2011

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The Dept. of Health and Human Services is reviewing the impact of physicians opting out of the Medicare program to determine if it's hurting beneficiary access in parts of the country.

The HHS Office of Inspector General announced the study along with dozens of others in its 2012 work plan. The office has 1,800 professionals who conduct audits and investigations to ferret out fraud, which can lead to civil penalties or administrative actions. The office also has inquiries into Medicare, Medicaid and public health programs to evaluate system performance.

The inspector general will gauge the impact of physicians who leave Medicare and determine if specific areas of the country have higher rates of departures than others, the work plan states. The office also is evaluating whether doctors continue to submit claims to Medicare on their patient's behalf after opting out.

The office does not comment on the work plan beyond the summaries listed in the report, said spokesman Don White. But health industry professionals believe the inspector general is right to study the issue.

Physician acceptance of new Medicare patients has decreased to 92.9% in 2008 from 95.5% in 2005, according to an article in the June 27 Archives of Internal Medicine (link). An Oct. 6 survey by the Texas Medical Assn. found 3% of members have opted out of the program, but 61% said they would consider leaving Medicare if payments were reduced significantly from current levels.

Physicians opting out of Medicare often form concierge practices, said Paul Spencer, a compliance officer for Fi-Med Management based in Wauwatosa, Wis. A 2010 Government Accountability Office study found 756 physicians had retainer-based arrangements, but Spencer believes many more physicians have decided to run concierge practices with smaller patient bases.

"With a primary care shortage in the country, the OIG first recognizes this could pose a problem if too many physicians leave," he said.

Federal officials also plan to monitor evaluation and management service billing. In 2009, Medicare paid $32 billion for these office visits, which represented 19% of Part B payments.

"Medicare contractors have noted an increased frequency of medical records with identical documentation across services," the work plan said. Auditors will check EMR documentation to ensure that the content supports the level of service on the claim.

Auditors will analyze Medicare claims data looking for high volume and unusual billing patterns, said Betsy Nicoletti, a physician practice consultant in Springfield, Vt. The inspector general also will evaluate quality of care and safety for certain services, such as patients transferred to postacute care from facilities and care provided at ambulatory surgery centers.

The work plan can be viewed on the inspector general's website (link).

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