Med school audit discussed
Faculty Senate told response will require enormous effort

By MARA McGINNIS
Reporter Assistant Editor

Michael Bernardino, vice president for health affairs, told the Faculty Senate Tuesday that the federal audit currently facing the School of Medicine and Biomedical Sciences is "quite sweeping in its scope" and that it will cost the school between $500,000 to $1 million just to respond to the subpoena, regardless of the legal outcome.

The document, which Bernardino called "massive," specifically named five to seven departments in the medical school and some faculty members to be investigated, he said. However, he said he believes that by the end of the process the entire school will undergo investigation. "No department will be left unlooked at," he said.

It will take enormous effort on the part of the medical school to respond to the subpoena, which asks the school to supply the names of all the residents it has trained over the past three years, their present location, their signatures and the names of their attending faculty. It also asks for meeting notes from all the departments from 1992 to present.

He added that it will be at least one to two more years at least until the school can gather the information.

Bernardino told senators that this type of investigation is the norm among private practices today and that 40 to 50 percent of medical schools have undergone such an audit. "We can expect to see more of this in the future," he said. However, of those approximately 40 schools, only three have emerged penalty free, according to Bernardino. The rest have incurred penalties ranging from $10 to $20 million.

Bernardino attributed the investigations to an attempt by the federal government to decrease the cost of health care and its obligation to Medicare and the state's obligation to Medicaid in the future. He also noted "draconian" reductions in funding to the teaching hospitals over the past few years and the government's tendency to consistently change the rules of how medical personnel can bill for services.

"There is an assumption here that there is a rational process that takes place. I don't want you to leave this room thinking the government is rational. I think that is very, very difficult for academic faculty to understand," he said in response to faculty concerns. "This is not a fair process."

Most of the penalties other schools are paying have been attributed to the miscoding of bills, which Bernardino said is the result of "the government taking portions of bills and then applying what they believe the rules are."

"This isn't something you negotiate or discuss (with the government)," he added.

But Bernardino said what worries him most is the permanent compliance penalty, or consent decree, that medical schools must face if brought up on charges. The compliance penalty, he explained, is an ongoing cost that requires the training and understanding of complex five-, six- and seven-digit billing codes that often have corresponding rules and regulations and are different for each department. "This has nothing to do with the practice of medicine, yet this is what we are being held to."

He noted that while the University of Pennsylvania incurred an initial penalty of $30 million, the ongoing compliance program now costs them an additional $3.7 million annually.

"(The coding practice) does not contribute to teaching and it detracts from patient care," said Jerome Yates, professor and associate director for clinical affairs at Roswell Park Cancer Institute. "It is preposterous and is a step backwards in terms of the quality of American medicine."

Bernardino noted that the complexity of the compliance program is compounded by the fact that every health-care facility has different rules for each code and that the federal government changes the rules for the codes about every six months.

Bernardino said that SUNY Stony Brook and Brooklyn are undergoing similar audits.

He added that the medical school also is attempting to improve upon its consortium agreement with affiliated local hospitals and bring its various practice plans into compliance.

In other business, the senate passed the resolution drafted by the Computer Services Committee that calls for the assessment of computing and technology support for faculty areas of responsibility.