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"Voluntary" compliance with mandatory rules.

For years physicians have been perceived in the eyes of the world as having it all in terms of prestige, economic success, and other advantages. It would seem that they now have it all in terms of responsibility for their billing actions, to conform to rigid, irrational, flagitious, arbitrarily conceived guidelines of the government.

A communique is available on the Internet at, where the Office of Inspector General's Compliance Program Guidance for Individual and Small Group Physician Practices, September 2000, spells out what is expected. The guidelines specify "voluntary compliance" by physicians but, in fact, under the False Claims Act and other laws governing healthcare fraud, physicians are vulnerable to sanctions to their practices, civil penalties, stiff fines, and possible felony conviction. Furthermore, no proof of intent to defraud is required. To make sure that physicians comply with Medicare law, the number of FBI fraud and abuse investigative agents has been greatly increased to formicate all over physicians.

The bottom line is that physicians practicing in the United States must immediately become thoroughly knowledgeable about the smallest details of CPT coding and billing and constantly monitor the performance of their staffs in this regard to make certain that the bills submitted comply with the government's guidelines. Brochures from teaching seminars offering time-consuming Medicare compliance sessions have proliferated in the physicians' mail. How can bureaucrats, who do not make the life-or-death decisions that physicians encounter daily, dictate that physicians spend their time on a task that should be delegated to a staff member? The time might come when the doctor can no longer risk dealing with the government as a third-party payer! We can only hope that time will never arrive.



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Publication:Ear, Nose and Throat Journal
Article Type:Brief Article
Geographic Code:1USA
Date:Aug 1, 2001
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