Emory Report

 September 2, 1997

 Volume 50, No. 2

Federal health care probe
involves Emory hospitals

The Atlanta Journal/Constitution reported Aug. 21 that 36 Georgia hospitals have been asked by the U.S. attorney's office to participate in a voluntary self-audit of outpatient laboratory billings to Medicare and Medicaid. Both Crawford Long and Emory Hospital received an inquiry letter from the U.S. attorney.

The probe extends to hospitals in seven other states. The government is concerned that laboratory billing was done incorrectly under the current rules and that violations mean hospitals received too much reimbursement. Joe Parker, president of the Georgia Hospital Association (GHA), of which Emory Hospital is a member, compared the inquiry to "a fishing expedition" in the AJC article.

The letter from the U.S. attorney asked hospitals to participate in a self-audit of claims submitted since August 1991. The letter suggests that participating hospitals would pay double the amount of any error found and incur no further penalties. Hospitals deciding not to participate could pay double the amount of the error plus penalties of $5,000 per incidence if the government finds the errors. The self-audits alone could cost each hospital $80,000, Parker told the AJC.

Emory has had an established compliance initiative for over a year. Karen Guarino, an attorney and director of compliance programs, joined Emory Healthcare in May 1997. She and Lori Spencer, Emory Healthcare general counsel, are overseeing the hospitals' response to this request.

"Billing requirements change frequently. Many times we need a technological solution, like software, to implement the change-and so does the government," Guarino said. "There can be a lag time between when rules change and when we have the tools to deal with them. And sometimes there is just a delay in getting clear information from the government to us. In any case, complying with the rules is complex and challenging for all of us."

She added, "We have been conducting an internal evaluation to collect as much information as possible. We have been in close discussion with the GHA, which has asked the U.S. attorney's office to better define the rules it believes were in place during the years covered by the investigation, and [to] provide their formula for reimbursement and other information that would help hospitals give thoughtful consideration about whether or not to participate in this voluntary self-audit program. We look forward to seeing the information requested by GHA and completing our internal evaluation to see what the real issues are in this instance."

Currently the hospitals have until Sept. 9 to decide if they will participate in the audit, but it is possible this date may be extended as the GHA and the U.S. attorney's office continue to discuss the hospitals' needs for further information.

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