Will Bush ease up on Health Fraud?

Doctors and hospitals, under siege by the anti-fraud forces unleashed by the Clinton administration, are hopeful that the new Bush administration will pursue health care fraud more judiciously and less rabidly than its predecessor.  They shouldn't hold their breaths.

Most doctors and physicians' organizations - such as the AMA - agree that the small number of doctors who are guilty of bilking the health care system should be caught and punished.  But the current anti-fraud push - launched in 1996 - goes way beyond merely nailing the guilty.  It is a "criminalization of the practice of medicine," according to Donald J. Palmisano, a doctor and a lawyer who is a member of the AMA board of trustees.

Palmisano and others note that current Medicare regulations make it virtually impossible for doctors to always be in compliance with each and every rule, guideline and directive.  They are just too complex and self-contradictory.  

What this means is that, when regulators choose to "go after" a physician - any physician - they are virtually guaranteed to find at least some violations.  Since the Clintons launched their great health care fraud initiative in 1996, regulators have accordingly hit the jackpot - and many doctors have cringed in fear, trying their best to comply with regulations, while praying they stay under the Feds' radar. (This, of course, is the point.  If you can get doctors to make every medical decision with the health care police in mind - much like every financial decision is made with the IRS in mind - then you have taken a great step toward covert rationing.)  It's just the old Regulatory Speed Trap.

But now Bush is president.  And doctors are hoping for an easing of the Draconian efforts of federal regulators.  After all, Bush pointed out in his campaign literature that Medicare regulations outweigh the tax code by three times.  And Tommy Thompson, the new HHS secretary, made a point during his confirmation hearings of that doctors and patients alike are fed up with the paperwork burden imposed by those regulations.

So, don't doctors have a reason for optimism?

Well, probably not, when you consider the nature of federal bureaucracies in general, and of the anti-health-care-fraud bureaucracy in particular.  In most federal bureaucracies, below the top two or three layers are the career bureaucrats, who survive through successive administrations.  In general, they don't survive by drastically changing their work habits every time an administration changes.  They survive by changing the memos they toss back up to their superiors.   But even more fundamentally, the anti-health-care-fraud bureaucracy gets to keep much of the money it generates by finding health care fraud - so the more vicious they are in uncovering fraud (however they define it,) the bigger, more powerful, and more stable the bureaucracy grows.  It's hard to imagine how anyone will stifle a bureaucracy such as this. 

Plus, we as a society still have a fundamental need to uncover lots and lots of health care fraud, since doing so - we've all chosen to believe - is what will keep us from having to ration health care.  It's going to be hard for the Bush people to appear to soften on uncovering these heinous activities. (Click here for a brief review of the anti-fraud imperative.)

Physicians, keep your heads down.

March, 2001

Back to news and commentary

YourDoctorintheFamily.com Home Page