ERIC Number: ED423741
Record Type: Non-Journal
Publication Date: 1998-Jul
Reference Count: N/A
Medicare. Concerns with Physicians at Teaching Hospitals (PATH) Audits. Report to the Chairman, Subcommittee on Health, Committee on Ways and Means, House of Representatives.
General Accounting Office, Washington, DC. Health, Education, and Human Services Div.
This report evaluates the Department of Health and Human Services PATH (Physicians at Teaching Hospitals) initiative involving audits of Medicare billing processes and procedures. The PATH audits resulted from concerns that medical records did not adequately document the direct involvement of teaching physicians in services provided by resident physicians and that some teaching physicians had "upcoded" claims, i.e., billed for more expensive services than were provided. The academic medical community has criticized the PATH initiative regarding the billing and documentation standards that were in effect during the time periods under review and contends that the Department of Justice is coercing settlements from teaching institutions. This report found that the Office of Inspector General (OIG) at Health and Human Services does have a legal basis for applying the specific criteria used in the PATH initiative and that the requirement that a teaching physician to be physically present to bill for services performed by residents is a longstanding requirement of the Medicare program. The evaluation also found that OIG's audit methodology was reasonable but that OIG's plan to audit all major teaching hospitals is probably not cost effective. Appendices detail the evaluation's scope and methodology and list key events related to the PATH initiative. (DB)
Descriptors: Accountability, Audits (Verification), College Faculty, Compliance (Legal), Federal Aid, Federal Programs, Higher Education, Medical Education, Medical Schools, Physicians
U.S. General Accounting Office, P.O. Box 37050, Washington, DC 20013; phone: 202-512-6000; fax: 202-512-6061; http://www.gao.gov (first copy free, additional copies, $2).
Publication Type: Opinion Papers; Reports - Evaluative
Education Level: N/A
Authoring Institution: General Accounting Office, Washington, DC. Health, Education, and Human Services Div.