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American Morning

Capitol Hill Investigates Insurance Seminars

Aired June 27, 2001 - 10:11   ET

THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.

THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
LEON HARRIS, CNN ANCHOR: The nation's health system is under the microscope on Capitol Hill today. At this moment, government watchdogs are releasing the results of an investigation into Medicaid and Medicare, and according to the probe, doctors are being coached on how to milk, and sometimes bilk, the systems.

Our medical news correspondent Rea Blakey joins us now with more - Rea.

REA BLAKEY, CNN MEDICAL NEWS CORRESPONDENT: Leon, it's not just Medicare and Medicaid that are at stake here, it's also public and private insurance companies that apparently were being targeted by these consultants. What we're going to see in the next few minutes, there is a hearing underway at Capitol Hill -- should be getting underway very shortly -- which essentially will take a look at a 13- month undercover investigation, which essentially was conducted by the General Accounting Office, which showed at least two seminars that were held in the Washington, D.C. area for physicians. Basically physicians were counseled and in some cases, actually instructed to basically over bill and/or under serve their patients.

Now, what we're talking about here is something to the tune of $54 billion reported in 1997 by the Coalition Against Insurance Fraud. So it's a great deal of money that could be at stake in regards to these potential fraudulent cases.

Let's just basically look at a synopsis of some of the charges that come out of this particular report. Basically the doctors were counseled to bill for care that they never actually provided themselves or care that was administered by their assistants, who actually would be coded at a lower cost. Also to reduce access for patients who have lower-paying insurance, for example, like a Medicare, so that the doctors could keep those patients out of rotation a little bit more. And also not to overpay or actually to report overpayments that doctors had received whether they be from private insurers or from public insurers like Medicare or Medicaid.

What we're talking about here is something that could potentially result in criminal and/or civil charges for these doctors if, in fact, they were to respond to the consultation, if they, in fact, billed the way they were told to in these particular seminars. It is against the law and, therefore, it's possible that criminal charges could result -- Leon.

HARRIS: What about the seminars themselves, are they considered illegal?

BLAKEY: Actually, seminars are conducted all the time because it's a very complex system, if you will, when you look at insurance coding. The American Medical Association puts out an annual report each year on the nomenclature that's used for coding a wide variety of all kinds of medical treatments and diagnosis, et cetera. And so it's a very complex and difficult system to navigate so these seminars are conducted quite frequently. These particular seminars, however, raised the ire of the GAO.

HARRIS: Interesting, so this story is not over yet.

Rea Blakey,...

BLAKEY: Not by a long shot.

HARRIS: ... appreciate the update. We'll talk to you later on.

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