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  • Agreement reached in documentation issue (6/12/98)

    The University of Texas Health Science Center at San Antonio, on behalf of its medical school faculty practice plan, has agreed to a settlement with the government to resolve an issue of incomplete documentation of services provided under Medicare, Medicaid and other federal health care programs.

    The Health Science Center disputes the contentions in this suit and has denied any liability or wrongdoing. Nothing in the settlement constitutes any finding by the government that the Health Science Center engaged in any misconduct or violated any regulations.

    The federal health care programs are important partners with the Health Science Center and the parties agreed that settling this case would allow the physicians to spend their energy and effort in continuing to provide excellent teaching and patient care, rather than engage in years of costly litigation and dispute with the federal government.

    The issue in the settlement was the adequacy of documentation of services by physicians from 1990 to 1995.

    Here is an example of "insufficient documentation" issues in this settlement:

    A faculty physician and a resident physician come into an operating room, perform an operation or provide the appropriate patient care. Care under the expert guidance of a teaching physician is given, and given well.

    The resident writes the operative note (summary of surgical procedure performed) for the patient chart and the faculty physician reads it, agrees with it and signs the note.

    The payment for services rendered are disallowed by Medicare because it is considered insufficient documentation.

    However, if the faculty physician had written the words "Reviewed and agreed" and then signed his or her name, the documentation would have been considered sufficient and, therefore, accepted as a billable service.

    Those three words constitute the difference between sufficient documentation and insufficient documentation.

    The lack of those three words adjacent to the faculty physician’s signature cost our physicians millions of dollars.

    All patient care was delivered and there were no issues about the quality of care, officials at the Health Science Center said.

    The settlement payment will be made through the medical school’s funds that are derived from physician income. No state appropriations to the Health Science Center will be used for the settlement.

    Under the settlement, the Health Science Center will return $9.8 million plus $7.4 million in interest and other charges.

    Since the period when the documentation problems occurred, and prior to the negotiations that led to this settlement, the Health Science Center implemented new documentation procedures that are designed to ensure that all physicians and billing personnel are fully trained in the revised documentation procedures. The U.S. Department of Health and Human Services recognized that the Health Science Center has established a responsible compliance program.

    The settlement was reached after a complaint was filed by a former employee of the Health Science Center.

    Attorneys representing the Health Science Center said the settlement was in the best interest of the institution by avoiding protracted and expensive litigation.

    The payments will be made in four installments over three years.

    The billings in question came during a period when federal guidelines for documenting Medicare services were widely acknowledged to be ambiguous. The federal guidelines were revised in 1996 after several years of national discussion among the government, Medicare providers and the health care professions.

    The Department of Health and Human Services is in the process of reviewing billing practices by teaching physicians in approximately 49 medical schools across the country. Many of these medical schools objected to the government’s efforts to apply these guidelines retroactively.

    Contact: Judy Wolf, (210) 567-2570