"Recalcitrant Providers" to Face Fines, Expulsion from Medicare — Physician’s First Watch

Medical News |
January 27, 2014

"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.

Reader Comments (2)

RALPH SLOAN Physician, Pulmonary Medicine

They should get gold stars!

danny lancaster Physician, Infectious Disease

MAY be fined or expelled?? Would seem aggressive action would be mandated. What about the professional organizations these providers are members of?

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