ANALYSIS OF FEDERALLY IMPOSED PENALTIES FOR VIOLATIONS OF THE CONSOLIDATED OMNIBUS RECONCILIATION ACT

Study objective: To identify the incidence of federally imposed penalt ies for violations of the Consolidated Omnibus Reconciliation Act(COBR A). Methods: Under the Freedom of Information Act, we retrieved a copy of any document related to fines imposed on, settlements made by, or litigation against physicians or hospitals as a result of COBRA violat ions from the Office of the Inspector General. Under a separate inquir y, also under the Freedom of Information Act, we requested and receive d from the central office of the Health Care Financing Administration the National Composite Log showing the status of all complaint investi gations pursuant to COBRA since the inception of the law. Results: One thousand seven hundred fifty-seven complaint investigations were auth orized. Of the 1,729 investigations completed, 412 (24%) were found to be out of compliance with federal regulations. Of these, 27 cases res ulted in fines imposed on hospitals. These fines ranged from $1,500 to $150,000 with a mean of $33,917, a median of $25,000, and a standard deviation of $35,899. The six fines that were imposed against physicia ns ranged in value from $2,500 to $20,000 with a mean of $8,500, a med ian of $7,500, and an SD of $8,612. Seven hospitals but no physicians were terminated from the Medicare program for COBRA violations. Conclu sion: The incidence of federally imposed penalties for COBRA violation s is low given the multitude of patient transfers that have occurred s ince the enactment of COBRA. The growing concern regarding this issue may be related to current litigation efforts to broaden the scope and applications of these laws.