Probe of Medical Centers Is Wise : The Need for Closer Scrutiny of UC Billing Practices is Clear

The UCI Medical Center is the hospital of last resort for many in Orange County. A large number of users are poor, their bills taken care of by programs like Medicare or Medi-Cal. For years the hospital has walked a financial tightrope, with medical costs increasing and income holding steady at best.

Now the medical center, which teaches physicians as well as healing the sick, has been accused of fraud connected to the bills it submitted to the federal government.

The accusations come from a former administrator of the University of California and a resident at one of its medical schools. The charges are contained in a “whistle-blower” lawsuit filed in San Francisco in May. The allegations have not been evaluated and a university official has speculated that the charges may have been encouraged by lawyers looking for money.

The lawsuit contended that physicians at UCI sometimes were not present throughout operations and occasionally did not see patients, although they told the government they did.

In keeping with federal law on whistle-blower suits, the U.S. attorney’s office is investigating. That is wise. So is a planned federal audit of all five UC medical centers -- Irvine, San Francisco, San Diego, Davis and Los Angeles. The need for closer scrutiny of billing practices by health-care providers across the country is clear. The General Accounting Office has estimated that fraud amounts to 10% of the Medicare budget. That would put the cost at over $17 billion a year.

Many hospitals in the United States have charged that federal rules are unclear on what can be charged to Medicare. UC hospitals either said they have abided by Medicare and Medi-Cal policies or declined to comment because they had not seen the lawsuit.

New regulations are in place to make it more clear what procedures and medical equipment the federal government will pay for and which examinations and operations require the physical presence of a doctor.

Medicare’s trustees said the program for the elderly and disabled would go broke in 2001 if the rate of growth in spending is not contained. One way to save money is by cracking down on fraud, which is why scrutiny of the programs is needed.