In a fairly recent Client Update, I highlighted the December 19, 2011 proposed rule implementing the Physician Payments Sunshine Act.  The Centers for Medicaid and Medicare Services (CMS) originally had stated that implementation would begin this year.  Well, physicians and manufacturers now are off the hook until at least 2013.  It turns out that for 2012 CMS will not be able to begin data collection required by the Act and any final rule that CMS adopts. 

In her May 3 letter to Senator Charles Grassley Marilyn Tavenner, CMS’ acting administrator, explained that “CMS does not believe it feasible to address all of the remaining issues” in time to finalize its rules on data collection for 2012.  For this year, disclosure of financial arrangements between physicians and manufacturers will not be required.   Tavenner assures us that a final rule will be produced later this year in time for the 2013 reporting season.

And just were these now-newly-charged defendants thinking?

 The Secretary of the DHHS and the US Attorney General just announced that 107 physicians and others have been charged in a Medicare scam, “breathtaking in scope.”  The allegations are that these 107 doctors, nurses, and others have defrauded the government of up to $452 million in Medicare payments.  The illegal activities occurred in Chicago, Houston, Los Angeles, Detroit, Tampa, and Baton Rouge, Louisiana.  Reports are that in the latter city alone seven individuals from two community health centers have been charged with submitting false claims of $225 million.

 What is sad is that the services of community mental health services are needed, and criminal activities such as these place ALL of these centers, and others, under the spotlight in a manner that can affect the delivery of care.  But the fraud appears so vast, and the amounts of money so great, that one cannot help but understand why there needs to be a laser-like focus on fraud and abuse and compliance.  I hope that as time goes on and the government’s efforts at fighting fraud start bearing real fruit in the form of reduced fraud (and consequent reduced governmental expenditures) that the good guys rise to the top.

 Oh, and the answer to the question above?   To paraphrase Willie Sutton, Medicare is where the money is – a lot of it.