Rebuffed by the Clinton administration, U.S. hospitals have turned to Congress in an effort to curb Medicare fraud prosecutions, using a pitch crafted to capitalize on the furor over abusive government investigators.
Their message is similar to the one heard time and again over the past year by witnesses who have testified before Congress about alleged abuses and strong-arm tactics by Internal Revenue Service investigators.Instead of choosing lawmakers who specialize in health, the hospitals found in the House an ex-prosecutor and a crime expert to spon-sor legislation to roll back a two-year crackdown on Medicare fraud. Industry executives argue that the crackdown has had the effect of criminalizing simple billing mistakes.
They also hired a top prosecutor, former U.S. Attorney Joseph diGenova, to lobby. Their message, delivered by hospital executives calling and visiting the Capitol, is that prosecutors are abusing the False Claims Act to coerce hospitals to pay fines and escape the threat of criminal prosecutions.
"You shouldn't be using capital punishment for jaywalking," said Richard Pollock, executive vice president of the American Hospital Association, sounding the rallying cry.
Congress appears to be listening. In less than two months, 165 House members agreed to sponsor the hospital-backed bill. A similar version was introduced in the Senate.
The effort is a textbook case of modern-day grass-roots lobbying: Develop a timely message, stick to it and have it delivered to lawmakers by influential leaders in their home communities. In this case, the front-line lobbyists are local hospital executives and the prominent community figures who sit on their boards of directors.
To mobilize its members, the AHA sent informational videos to hospital officials. It set up a form letter on its Internet site so executives could contact their lawmakers with just a few clicks of a computer mouse.
When hospital administrators assembled here in January for their annual convention, they visited the offices of lawmakers to lobby them personally.
The False Claims Act provides for triple damages and fines of up to $10,000 for seeking to defraud or defrauding the government. Medicare lost $20 billion to fraud, waste and simple error last year, according to the Department of Health and Human Services.
Two years ago, President Clinton announced a crackdown on Medicare fraud. Since then, hospital officials allege, overzealous federal prosecutors have been using the False Claims Act even in cases of innocent billing mistakes, in an effort to help achieve the $115 billion in Medicare savings called for in last year's balanced budget agreement.
Rep. Pete Stark, D-Calif., who is leading the fight against the bill the industry wants, charges that the legislation is really an effort to help Columbia/HCA Healthcare Corp., the subject of an ongoing massive federal probe into allegations it overcharged for Medicare, Medicaid and other government health care programs.
"No one who obeys the rules is being harassed," Stark said. "The issue is a few bad apples who control the AHA are getting the good guys to do their dirty work for them."
Pollock said the issue arose before the Columbia/HCA investigation and the bill wouldn't affect that case.
"We're not talking about fraud and abuse in almost all of these situations," he said. "We're talking about billing errors and mistakes and disputes. We know that we do make mistakes. We'll pay them back with penalties."
When it came time to introduce a bill encompassing their concerns, hospital officials sought experts in law enforcement rather than health care: Rep. Bill McCollum, R-Fla., chairman of the House Judiciary crime subcommittee, and Rep. Bill Delahunt, D-Mass., a former local prosecutor.