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GAO-01-802R 1 (2001-06-11)

handle is hein.gao/gaocrptannl0001 and id is 1 raw text is: SGAO Accountability * Integrity Reliability United States General Accounting Office Washington, DC 20548 June 11, 2001 The Honorable Max Baucus Chairman The Honorable Charles E. Grassley Ranking Minority Member Committee on Finance United States Senate Subject: Regulatory Issues for Medicare Providers With services delivered by hundreds of thousands of providers to nearly 40 million beneficiaries and payments of about $220 billion in fiscal year 2000, Medicare is highly vulnerable to fraud, waste, and abuse.' The process of enforcing program payment rules, however, has raised concerns that the impact of these safeguard activities has imposed too great a burden on health care providers. Concerns about the regulatory burden facing providers include perceptions of unreasonable or unclear demands for documentation from the Health Care Financing Administration's (HCFA) payment contractors, excessive paperwork, and a belief that Medicare contractors unfairly pursue and investigate physicians who have made innocent billing errors. The Medicare Education and Regulatory Fairness Act (MERFA)-S. 452 and H.R. 868-has been introduced to address some of these concerns. The bills would provide expedited procedures for provider appeals, new options for providers to use in repaying Medicare overpayments, protections for providers who voluntarily return overpayments or ask for a review of their claims, and new requirements for provider education. This letter responds to your May 16, 2001, request that we provide information on several issues addressed in S. 452. You asked us 18 specific questions about how the proposed legislation would affect Medicare policies and procedures in the following areas: (1) provider education and participation, (2) medical reviews, audits, and appeals, (3) recovery of overpayments, and (4) related legal issues. You also asked that we identify alternative solutions that could address provider concerns while maintaining program integrity. To address these issues, we collected information from HCFA, the Department of Health and Human Services' Office of the Inspector General (HHS/OIG), and the Department of Justice (DOJ) about their roles and responsibilities. We also compared the proposed legislation to current laws and regulations and examined relevant agency materials. Regarding alternative approaches to these issues, we reviewed suggested modifications to specific provisions of 1High Risk Series: An Update (GAO-01-263, January 2001). GAO-01-802R Regulatory Issues for Medicare Providers

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