"Recalcitrant Providers" to Face Fines, Expulsion from Medicare

By Amy Orciari Herman

"Recalcitrant providers" — those who abuse Medicare by, for example, repeatedly overcharging for services and then refuse to change their behavior even after educational intervention — may be fined or expelled from Medicare and other federal health programs, according to a new Health and Human Services directive highlighted this weekend by the New York Times.

Officials say roughly 10% of payments in the traditional fee-for-service Medicare program are inappropriate, the Times reports, translating to an estimated $6 billion of improper payments annually.

In addition, an HHS audit found that in 2009, Medicare payments exceeded $3 million for each of 300 physicians (over half were internists); a third of these physicians were flagged for questionable activity. Investigators write that "identifying clinicians who are responsible for high cumulative payments could be a useful means of identifying possible improper payments."

The Times notes that beginning on Mar. 18, Medicare officials will be allowed to publicly disclose payments made to individual physicians.