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Paperwork is Drowning the Medical Profession

A very insightful article recently appeared in The Washington Post which describes the increasingly onerous paperwork and regulatory burdens imposed upon the medical profession. The article also stresses how physicians can be subject to civil and criminal liability for erroneous claims billed to the Health Care Financing Administration (HCFA) under the Medicare program. This is so in spite the lack of a single, authoritative source about billing and coding questions, ever-changing policies and regulations, and varied interpretation/implementation of HCFA policies by different private carriers.

While measures to prevent fraud and abuse are necessary, CRE agrees with the author that current administrative requirements are exerting negative pressures on the proper practice of medicine. Medical practices are among America’s most important small businesses, so paperwork burdens should be minimized, both to reduce costs and to increase time allotted to patient care.

CRE is one of the few organizations that has been asking for reforms under the Paperwork Reduction Act. Unfortunately, paperwork reduction continues to be a low priority, as it does not have the direct policy implications of significant agency regulations. However the collective burden on society is great, as the Washington Post article demonstrates. Thus, CRE hopes that the new Administration will assign a high priority to reform in this important area.

Summary of the Washington Post Article

In the January 21, 2001 edition of the Washington Post (at B3), there was printed an article entitled "A Look At ... Quitting Medicine. It’s Not the Job, It’s the OIG and the 99203s." The piece was written by Leonard Laster, Distinguished University Professor of Medicine and Health Policy and Chancellor Emeritus at the University of Massachusetts Medical Center. The main points of the article were as follows:

  • The nature of the medical profession is changing dramatically, particularly with the advent of HMOs and increasing paperwork requirements imposed from both the public and private sectors. As a result, many excellent physicians at the peak of their careers are either leaving practice or contemplating doing so.


  • Doctors have a very difficult time keeping current with existing and new regulatory requirements under Medicare. (Needless to say, practitioners are not generally in the habit of reading the Federal Register.) According to the article, doctors feel themselves at the mercy of agencies such as the Health Care Financing Administration (HCFA), the Office of the Inspector General of HHS (OIG), and the Department of Justice (DOJ) which enforces actions for fraud and malfeasance.


  • The article details the numerous administrative and paperwork hoops through which physicians must jump in order to be paid for their services. Make a misstep and the following unpleasantries could result:
    • If doctors make a mistake, they can face audits.


    • If a doctors is found to have "upcoded" his bill, he may have to reimburse HCFA. (Appeals of such decisions are long and time consuming.)


    • Finding of a "reckless or intentionally fraudulent" claim could result in fines or even a prison term of up to ten years.

    Although HCFA does not presume intentional wrong doing, the threat of involvement in a fraud case can be intimidating and formidable.


  • Problems with the current system include:
    • Changing nature of HCFA and OIG regulations.


    • Lack of a single guide to coding and billing questions.


    • Varied implementation of HCFA policies by different carriers.

  • According to the article, the big losers are the American people, since many excellent and caring medical professionals are being driven from practice.


    • Recommendations include:
    • Clarify and simplify the rules.


    • Require HCFA carriers to implement the rules consistently.


    • Provide educational materials which help doctors understand the system.


    • Minimize rule changes or schedule such changes at regular intervals.

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