Spine Society Issues Health Fraud Alert

By Editorial Staff

The North American Spine Society (NASS) has issued a "special alert" to all of its members regarding a "cracking down on health fraud" by the Health Care Financing Administration (HCFA) and the U.S. Department of Justice. The alert includes these sobering facts:

• "The OIG (Office of the Inspector General) plans to double its staff by 2002 to investigate health fraud.

• "For every dollar that the OIG spends to track down fraud, it recovers $10.

• "There are expanded civil and criminal penalties for health fraud, including fines of $10,000 PER OFFENSE (emphasis theirs), mandatory 1-3 year jail sentence for a felony fraud conviction, and exclusion from participation in federal programs."

The Health Insurance Portability and Accountability Act of 1996 (aka the Kennedy-Kassebaum bill, HR 3103) has provided $820 million over seven years to the Office of the Inspector General for health fraud investigation. Those funds have been allotted to the FBI ($548 million) and the Department of Justice ($330 million).

The primary suggestion made by NASS is for providers to learn and use "correct coding" when billing for reimbursement. This not only helps ensure payment, but can also protect a provider from future accusations.

About the NASS: The NASS, begun 14 years ago, defines itself as a "multidisciplinary organization that advances quality spine care through education, research and advocacy." NASS currently has 2,038 members (1,934 from the U.S.). Sixty-three percent of NASS members are orthopaedic surgeons; 18 percent are neurosurgeons; and 9% are physiatrists.

NASS has six categories of membership. Chiropractors are in the "affiliate" membership group, which also includes PTs, PAs, nurse practitioners and other allied health care professionals and individuals involved in spine research/development. The affiliate group accounts for only two percent of NASS membership.

The NASS meets annually. This year's meeting (Chicago, October 20-23) will feature guest speakers Dr. C. Everett Koop, former Surgeon General of the United States, and Dr. John Eisenberg, the AHCPR's administrator, among others.

The NASS website is www.spine.org .