August 2000 Bulletin

AAOS says Congress should simplify HCFA regulations

The American Association of Orthopaedic Surgeons recommended to a U.S. House subcommittee in June that Congress should simplify and clarify Health Care Financing Administration regulations related to the Medicare programs so that they are less burdensome and more easily understood by physicians.

Federal fraud and abuse regulations were so complex and burdensome that time once spent treating patients is now being spent completing mandatory documentation and billing requirements, as well as other regulatory obligations, the AAOS said in a statement to the House Commerce Committee Subcommittee on Health and Environment. Not only are physicians spending more time away from treating patients, but also HCFA’s requirements are making it difficult and sometimes impossible for doctors to accept new Medicare patients.

"The biggest problem in this area of federal regulations is there is no ‘bright line’ as to what constitutes ‘illegal’ or improper conduct," the AAOS said. "The presumption running through these regulations is that physicians are violating the law and are guilty of defrauding the government, unless they can document otherwise."

The AAOS said congressional oversight is needed for the aggressive and overreaching authority by federal agencies, complex and contradictory regulations and increased documentation requirements and limited due process.

As long as the pursuit of fraud is viewed as a "bounty" or revenue-raising activity, cost-containment measure, or a way to expand program benefits, overzealous investigations of physician coding and billing activities will continue, the AAOS said.

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