City med. school fined by U.S. gov't

Thomas Jefferson disciplined for same Medicare error as U. Thomas Jefferson University recently settled a $12 million lawsuit involving claims that its physicians overbilled patients -- less than a year after Penn faced a similar suit. Federal inquiries into many university hospitals' billing practices began last year after Penn agreed to pay $30 million to the federal government, settling claims that Medical School faculty members overbilled Medicare by $10 million for treating Hospital of the University of Pennsylvania patients over the last six years. Although Penn had to pay triple the amount of its original overbilling, the suit against Philadelphia-based Thomas Jefferson only cost the university double its overbilling fees. Auditors cited the fact that Thomas Jefferson had conducted its own audits in deciding to lower the settlement amount. The audit -- which the government is expanding to include more universities -- revealed similar violations at Penn and Thomas Jefferson. Investigators found that HUP doctors were billing patients for care provided by resident physicians. Under Medicare, residents are not allowed to charge for the care they give because the federal government already subsidizes their training and salaries. Likewise, most of the overcharges at Thomas Jefferson were for medical services provided by residents, though the patients' bills claimed faculty doctors performed the procedures. Officials at Thomas Jefferson -- like Penn administrators -- denied any wrongdoing, noting that "past Medicare guidelines were subject to interpretation." According to Robert Dickler, a senior vice president of the Association of American Medical Colleges, Medicare regulations have been unclear for decades. Dickler said there is enough ambiguity in the rules as they are written that the physicians could have "thought the bills they rendered were in compliance with the regulations and documentation." Dickler added that new Medicare regulations implemented in July should help eliminate any confusion over billing practices. "They are significantly more explicit in both what requirements must be fulfilled and in what needs documentation," Dickler said. "I think they'll go along way in clearing up some ambiguity." Following Penn's settlement, the government announced it would study six more Pennsylvania hospitals -- Thomas Jefferson, Albert Einstein Medical Center, Graduate Hospital, the Medical College of Pennsylvania-Hahnemann University Hospital, Temple University Hospital and the University of Pittsburgh Medical Center. But auditors eventually may examine all of the nation's 125 academic medical centers -- and possibly all 1,200 universities that receive Medicare money for graduate medical education. As part of Penn's settlement, the Clinical Practices of the University of Pennsylvania agreed to implement a four-part plan to increase its compliance with Medicare regulations over the next five years. Part of the plan involves conducting internal and external audits, a practice the government has recommended all university hospitals establish. Thomas Jefferson officials have also agreed to develop a compliance plan, according to Thomas Jefferson spokesperson Carol Lynn Daly. "It is regrettable that these billing errors occurred," Daly said in a statement. "In order to correct these deficiencies, TJU's Office of Corporate Compliance is implementing a program to ensure future adherence with all billing regulations." Daly added that Thomas Jefferson chose to settle with the government to avoid "long and costly litigation." Penn Health System spokesperson Lori Doyle had no comment on Thomas Jefferson's specific case. However, Doyle did say that Penn Medical Center officials have "known all along" that Penn was not the only university with misunderstandings regarding Medicare billing.

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