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Re: $10,000 fine for an honest coding error!From: OBDocRick@aol.comFri Jun 7 15:41:00 1996
Dear List companeros A friend of mine works in Sen. Kennedy's office. After reading the post I forwarded it to her. The response is below. I can give the number to anyone who would like it, but left it out to protect privacy. Rick Chudacoff, MD Subj: Fwd: Re: $10,000 fine for an honest coding error! Date: Fri, Jun 07, 1996 11:27 AM PST From: Suzanne_@kennedy.senate.gov To: OBDocRick@aol.com Rick: Danielle asked me to respond to this article. The provisions named in the article are in the Kennedy-Kassebaum bill, but were placed there by Senator Dole, as part of one of his amendments. Senator Kennedy does not support it and hopes to get rid of it during the conference. If there is anything more that I can do for you, please feel free to call me at Suzanne Date: 6/7/96 2:04 PM Suzanne: Rick is a good friend of my sisters....also an OB/GYN Doctor. Could you please let him know if the info in the following article is accurate. Thanks, Danielle Date: 6/7/96 13:04
Received: by ccmail from mailhost.senate.gov
>From @gateway.senate.gov:OBDocRick@aol.com Danielle Is this correct? I got it off my BO/GYN listserve. Rick --------------------- Forwarded message: --------------------- From: perinatl@slip.net (D. G. Huffman) --------------------- To: OBDocRick@aol.com Date: 96-06-07 00:08:30 EDT
At 10:52 AM 6/2/96 -0400, you wrote:
>Dean Sorry for the delay. I have been out of town. Dean Huffman ********************
Here is the article: Health Bill Would Shackle Doctors -- Literally By James M. Orient Sending doctors or patients to federal prison in order to protect health plans from paying too much was one the most loathsome features of the defeated Clinton Health Security Act. Now it's back, passed by both houses of Congress, voted for by all 150 senators. However, all attention is focused on the argument over revised tax treatment for medical savings accounts, a feature of the House but not the Senate bill. Here are some highlights of both versions of the Kassebaum-Kennedy health care bill: five years in prison for making a misstatement to your health plan (say you "forgot" to mention a pre-existing condition); 10 years in prison for intentionally "misapplying" any assets of the plan (say to a "medically unnecessary service that nonetheless relieves your symptoms): one year in prison if the "misapplied" amount is less than $100; five years in prison for failing to turn over a patient's records (say to a prosecutor who wants to accuse him of making a misstatement to the plan); life in prison if a plan is "defrauded" in connection with the care of a patient who dies. And that's not all. The bill also calls for fines of $10,000 for each instance of "incorrect" coding, even an honest mistake, on insurance claims (there are thousands of codes and no consistent interpretation); fines and/or prison for those who "transfer items or services for free or for other than fair market value" (i.e., who provide unauthorized charity): automatic seizure of all property paid for with the gross proceeds of any "federal health care offense" (and all offenses related to any health insurance plan, public or private, will be federal offenses). The message sent by the Kassebaum-Kennedy bill is loud and clear: Any doctor who practices fee-for-service medicine has to put it all on the line -- his house, his car, his office, his bank account, and most of all, his liberty. If he "fails to comply with a statutory obligation" to provide only "medically necessary" services, correctly coded, he can be reduced to lifelong poverty and imprisoned besides. The law enforcement machinery will be vastly augmented to meet the challenge. There will be rewards to informants, and prosecutors get to keep the fines and seized property. If the enforcers need evidence, they can seize anybody's medical records anytime (this will be even easier once the records are on a computer network). When opponents of the Clinton plan pointed out provisions like this, nobody, Democrat or Republican, actually tried to defend the criminalization of medicine. The opponents were called "liars," but all they had to do was carry a copy of the plan around and invite people to read it. The Clintons made a big mistake: They tried to keep the work of the task force a secret. That made people too curious. The Kassebaum-Kennedy bill is no secret. And the criminal provisions are not discreetly buried in some 1,300 page document. The Kassehaum-Kennedy "antifraud" and "administrative simplification" (forced computerization provisions are about a third of the whole bill. How, then, did this bill pass? I think the answer must be this: Nobody reads. Congressmen don't read the bills: they just pate them. Sen. John Chafee's (R, R.I.) staff actually told one constituent that the senator didn't even care what was in the bill, as long as it passed! Reporters don't read the hills either. So here's the strategy: If you want to peas something that almost everyone will hate, slip it into a bill that Congress is desperate to pass just before an election so congressmen can say they "passed health care reform" or something equally popular. And talk about your good intentions: portability, "access" and (by the way) "tougher" sanctions against fraud and waste (skip the devilish details). Despite the current bill's Draconian enforcement provisions, much of the debate over Kassehaum-Kennedy focuses on modifying the tax code, which now discriminates against people who buy their own insurance or who have large deductibles and pay most medical bills directly rather than through an employer-provided insurance plan. Some people think that medical sayings accounts, which allow individuals to decide how to spend their health care resources, would be the death knell for managed care. Why pay a third party or middleman to manage your money (and deny you access to medical services you want) when you could make your own decisions and keep any savings? If favorable tax treatment for medical savings accounts makes it into Kassehaum-Kennedy and these "antifraud" provisions survive, it will be a Pyrrhic victory. Sure, you can have an MSA. But just try to find a doctor who will treat you. No wonder HMO executives look so smug. They bash MSAs, but they don't have to worry very much; with this bill, they win either way. Doctors who do not aspire to martyrdom have a number of options under Kassebaum-Kennedy: Open a pizza parlor, retire altogether (and hope they don't get sick themselves), or sign a capitation contract with an HMO. If they sign on, they may get $10 per month for each person they don't see. And they need not live in fear of a knock on the door from the FBI. (If the HMO runs afoul of the law, the HMO just has to file a corrections plan.) After we finish eliminating fraud by individual doctors (by driving them out of practice), maybe we can start on real campaign reform for congressmen: one year in prison for misstating a campaign expenditure by $100 or less, and 10 years for misstatements involving more than $100. It's a matter of equality under the law. If we can't hope for private doctors to have the same due process rights as people accused of rape or aggravated assault, let's at least assure that congressmen are treated as well as private doctors and their patients - - - - - - - - - - - =============================================================== Dean G. Huffman Phone: 217 787-3745 FAX 217 787-0680 perinatl@slip.net 217 782-9666 217 524-2432 Never try to teach a pig to sing. It wastes your time and it annoys the pig. H ===============================================================
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>From Suzanne_Morse@kennedy.senate.gov Fri Jun 7 15:26:51 1996
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