Federal fraud and abuse laws and Medicare rules designed to prevent overbilling may have the unintended effect of discouraging health care providers from offering reduced-cost or free care to patients. In part because of these rules, many hospitals have not established procedures for identifying and offering discounts to patients who lack the means to pay large medical bills.
"Medical debt can undermine the financial stability of low- and middle-income individuals unlucky enough to get sick, forcing them and their families to change their way of life," said Karen Davis, president of The Commonwealth Fund. "Saddling people with large medical bills they can't afford to pay doesn't benefit providers or patients."
In Unintended Consequences: How Federal Regulations and Hospital Policies Can Leave Patients in Debt, lead author Carol Pryor and colleagues with Brandeis University's Access Project recommend several policy options to alleviate burdensome and unmanageable medical bill problems. They say that the federal Centers for Medicare and Medicaid Services (CMS) could clarify its rules to address providers' concerns, for example, and that hospitals could establish standard criteria and simplify applications for free or reduced-cost care.
Federal Regulations Place Burden on Providers
While intended to prevent overbilling and the provision of unnecessary care, Medicare regulations and CMS fraud and abuse laws often end up discouraging hospitals from reducing fees for some of their patients. Routinely waiving fees for Medicare patients, for example, is prohibited because it may violate anti-kickbac
Contact: Mary Mahon