1% of Doctors Get Medicare Reviews

Reviews to detect Medicare overpayments were done on fewer than 1% of the doctors who bill the federal health insurance program, a congressional investigator said Wednesday.

The reviews by Medicare’s private contractors are an important way to identify physicians who have been paid too much to treat the elderly and disabled, auditor William Scanlon said at a House Budget Committee hearing.

In the 2000 budget year, those private contractors reviewed the medical claims of 1,891 physicians out of more than 600,000 who billed Medicare that year, said Scanlon, who covers health issues for the General Accounting Office, the investigative arm of Congress.

Most Medicare payments are proper, Scanlon said. But the program “faces a difficult task in finding an appropriate balance between ensuring that Medicare only pays for services allowed by law and making it as simple as possible for providers to treat Medicare beneficiaries and bill the program.”

In 1999, payments made in error amounted to $11.9 billion, the government has reported.

At the hearing, government and academic experts said Congress should pay more attention to the financial health of the 36-year-old program. Government projections earlier this year predicted Medicare, a $240-billion program, would start running short of cash in about 15 years.

An official at the agency that runs Medicare promised a turnaround on all counts.

“In no way will we diminish our interest in fighting waste, fraud and error in the Medicare program,” said Ruben J. King-Shaw Jr., the chief operating officer for the Centers for Medicare and Medicaid Services.

“For the small percentage of people who take advantage of the system, we will continue our aggressive efforts to protect the funds that taxpayers have entrusted to us.”

Financial experts also told Congress that the goals of overhauling Medicare and adding a popular prescription drug benefit could be too much all at once.

“Medicare’s future will likely be written numerous times as health care changes and baby boomers move through the system,” said Marilyn Moon, a health economist at the nonpartisan Urban Institute.

There were also warnings about encouraging private health plans to compete with the federal program. President Bush promoted the idea this month.

Bush said he wants more health maintenance organizations and private health plans to compete for seniors’ business within the underlying Medicare program; 15% of the 40 million enrollees use private plans. Bush said such competition could bring better service, lower premiums and extra benefits, such as complete drug coverage.

But the government would have to make sure it helps all seniors, regardless of which plan they are in, said Comptroller General David Walker, head of the GAO.

“Separating winners from losers is a basic function of competition,” Walker said in a report to Congress.