August 1999 Bulletin

Shalala told 'bounty' program wrong

Campaign to turn elderly into 'watch dogs' destroys physician/patient bond, says Dr. Tipton

The following letter was written by William W. Tipton Jr.,MD, AAOS executive vice president, to Donna Shalala, Secretary of the Department of Health and Human Services

The Honorable Donna Shalala

Secretary of the Department of Health and Human Services

200 Independence Avenue, SW

Washington, D.C. 20201

Dear Madam Secretary:

I am writing on behalf of the 23,000 members of the American Association of Orthopaedic Surgeons to express our profound anger and disappointment over the government's latest initiative to deal with Medicare fraud and abuse: the Who Pays? You Pay campaign. This campaign, which your department is sponsoring with the American Association of Retired Persons, is designed to make Medicare beneficiaries so suspicious of their doctors that they will become the government's "watch dogs" for fraud and abuse. To reinforce this notion, you are even using a technique from the Old West by offering a $1,000 bounty to beneficiaries if their allegations of fraud and abuse lead to punitive action against their physicians.

This campaign is giving Medicare beneficiaries the impression that fraud and abuse is rampant and that physicians are intentionally out to cheat them and the government. In fact, the findings of your own department indicate that this impression is false. In February of this year, your office reported that overpayments to Medicare providers went down by a dramatic 45 percent between 1996 and 1998. Your office also reported that last year's overpayment rate was the lowest since the government started comprehensive audits three years ago. Most importantly, your own inspector general concluded that inadvertent mistakes, as well as outright fraud and abuse, cause overpayments, and that the portion attributable to fraud and abuse could not be determined.

There are over 100,000 pages of health care regulations covering Medicare. As you know, many of these regulations are lengthy and complex. As you are undoubtedly aware, even the Health Care Financing Administration has difficulty providing clear guidance and interpretation of these regulations.

Since physicians and other health care professionals must deal with this mass of confusing rules, it should not be surprising that they make mistakes. While we freely acknowledge that fraud and abuse also takes place, we believe that most physicians get incorrect payments (both too high and too low) by mistake, not because they are out to bilk the system.

However, instead of simplifying the rules and helping physicians better understand them, your department, through this campaign, is trying to absolve itself of responsibility and shift the entire blame for Medicare waste to the medical profession.

This cynical campaign has the taste, smell and feel of something out of George Orwell's 1984, and it will drive a wedge between physicians and patients the likes of which have not been seen before.

If patients start to believe that doctors are criminals and that their job is to help the government prove it, how do you think this will affect their trust and confidence in their physicians? And, if physicians start being bombarded with audits and investigations because of patient allegations of fraud, how do you think this will affect their ability to interact with their patients? Also, have you considered the possibility that more physicians will leave medicine because of the hassle factors that this campaign will create?

While it may seem to some like an outdated notion, the physician/patient relationship is still the foundation of the American health care system. Even with the tremendous advances that have taken place in medicine, this relationship is still the key to getting good patient care results.

The American Association of Orthopaedic Surgeons shares your concern about reducing the amount of waste in the Medicare program, but creating distrust between Medicare beneficiaries and their doctors is not the way to do it. Rather, we should work together to simplify and clarify the Medicare rules, eliminating ambiguities and inconsistencies.

Therefore, I urge you to reconsider the Who Pays? You Pay campaign, keeping in mind the detrimental effect that it will have on the physician/patient relationship. If this approach is continued, I believe it will prove much more costly to the Medicare program than the fraud and abuse it is suppose to eliminate.


William W. Tipton, Jr., M.D.

Executive Vice President

cc: Honorable Albert Gore, Jr., Vice President of the United States

Honorable J. Dennis Hastert, Speaker of the United States House of Representatives

Honorable William M. Thomas, Chair, Subcommittee on Health, House Ways and Means Committee, United States House of Representatives

Honorable William V. Roth, Jr., Chair, Senate Finance Committee, United States Senate

Nancy-Ann Min DeParle, Administrator, Health Care Financing Administration

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