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In Macon, Georgia the new budget took away $475,000 from the Medical Center of Central Georgia funding. The reduced funding in turn has cost the jobs of six of 16 school nursing positions plus a cutback in the hours the pharmacy will be open. The remaining 10 nurses will cover 41 schools. This will probably mean there will be less early detection of disease and more emergency room visits causing more cost to the county. Penny wise and dollar foolish. Top
Texas Allows Physicians to Negotiate
The Texas Attorney General has allowed a group of 12 independent practitioners to band together in order to negotiate with insurance companies. This is the first time this has been allowed under the nation's first law in 1999 allowing the grouping of physicians. Blue Cross/Blue Shield of Texas, with whom the physicians wish to negotiate, has stated they will not negotiate with the group. The physicians will be represented by their hospital managed care director. The physicians could refuse en masse to drop the contract and won't be charged with anti-trust violations. Top
The Jewish Hospital in Louisville has agreed to pay $226,000 in fines. This is interesting since it was originally charged with overbilling cardiac catheters to the tune of $13 million. The whistleblower was doing a routine audit and noticed irregularities. He gets $36,000 and will be blackballed from ever working in the healthcare field again.
Our Lady of Lourdes Regional Medical Center in Lafayette, LA is to pay a fine of $247,182 for billing errors. They were found to have misbilled 9 times in 50,000 audited records. I think that is terrific and the government should have paid them.
Nanticoke Memorial of Seaford, Delaware and its Medicare cost accountant, McBee Associates of Maryland, have agreed, without admitting any liability, to pay $756,302 for allegations under the False Claims Act. They were accused of fraudulently claiming costs for retirement benefits which are not reimbursable by Medicare. Nanticoke is to pay $567,277 within five days and McBee is to pay the remainder in three installments and 6.5% interest.
B. J. Carlen, Inc (Pastor Medical Associates) of Boston has agreed to pay $230,000 to settle Stark violations of referring to their own labs. This is a whistleblower case. The whistleblower, Dr. Averback, who practices in the same area will receive $41,400. I wonder if there is any prior employment issues between the physician and Pastor.
Caritas Medical Group in Boston is also to pay a false claim penalty for one of its physician's billings. The group will pay $191,521 to the feds and $5215 to the Mass. Medicaid program. The doctor used EM codes that were too high and billed for non-existent services. The Group found out and self reported which resulted in a much lower than usual fine. Top
In yet another Boston case, Newton-Wellesley has agreed to pay $3.3 million for upcoding claims on the treatment of pneumonia. The whistleblower here is Health Outcomes Technology which will receive $462,000 for its share. The hospital also paid last year an additional $231,000 for improper lab billings.
The University of Colorado has agreed to pay $1.2 million to settle allegations of false claims. The claim is that the hospital improperly billed for pneumonia and angina and for lab tests that did not comply with rules or were not supported by physician orders in the medical records.
The University of Florida has agreed to pay $8.6 million to settle wrongful billing practices by it's covering physicians. The payment will not come from taxpayers but from the fund used to pay physicians. It will be paid in 4 installments and over a five-year period. The whistleblower is a retinal specialist in Gainesville.
CVS, the nations largest pharmacy chain, has agreed to pay $4 million for false claims to government insurance programs. They did not admit to liability. The allegation charged the billing of a full prescription when only a partial quantity was dispensed. This is common that when a pharmacy does not have enough of a medication they only give part and have the patient come back for the remainder. The problem is when the patient does not come back and there is no return of the extra money to the Medicaid program.
A Philadelphia orthopedic surgeon will pay a $1.9 million fine and be forced to enter into a CIA with the feds to settle allegations of false claims for two years. This stems from surgery performed by residents and billed under the surgeon's name. Reconstructive Orthopedic Associates will pay an additional $200,000 for the same offenses. The CIA requires a five year independent audit of his operative notes and Medicare billings. Top
Jacksonville, Florida Baptist medical Center Nassau will lose its ability to treat Medicare & Medicaid patients if it doesn't get its on call roster in order. The hospital did not meet its obligations when first reviewed earlier this year. They did not put up the required signage nor have backup surgeons. The signage has been fixed but not the surgical issue. They are short on surgeons since one is ill and another left. They are recruiting another surgeon. They could also make arrangements with another hospital to take their surgical patients. Top
President Bush has changed the onerous everybody must do everything rules of the Clinton Medicaid patient rights to a softer more compassionate rule. This rule gives all the general protections to all patients but allows the states to modify those aspects such as lead testing which isn't needed in all states. The comment period is now open and the Democrats want the original back. The Governors side with Bush. Top
The Texas Department of Insurance is fining the insurers $1000 per day per claim for not paying promptly. The insurers also have until October to pay restitution to all providers they have not paid. In their usual scare tactic the plans state the fines will be paid by businesses and consumers. This may be true but that would mean the businesses would not deal with plans that raised their rate due to the plans negligence. The fines range from a high of $1.5 million against Blue Cross/Shield and One Health to $1.25 million against Cigna, Humana, Sierra, Unicare and United.
New Jersey hospitals are putting the pressure on insurers in their state to also get their act together for compliance with the state's prompt payment law. Top
Abbott and other makers of enteral products are under investigation. The investigation is being handled by the Southern Illinois U.S. Attorney's office, which has prior experience with fraud. The investigation centers on the manufacturers, distributors, and providers. There was a national raid on July 26. The question is whether the pumps and the supplies are being given away at below market price to the government paid patients and then billed to the government at the standard price. Abbott is also part of the proposed $840 million settlement for its role in the Lupron scandal. Top
Montgomery County Hospital have really gone out on a limb. Instead of joining its Harris County counterparts in suing for the non-emergent treatment of undocumented aliens, they have issued a letter to the Attorney General to rethink his position. Spine transplant still needed.
The El Paso Commissioners voted to support their hospital's decision to continue to give non-emergent care to undocumented aliens who live in the district. They got the spine transplant. Top
The FDA has issued a guideline to ban blood donations from people who have spent at least three months in Great Britain between 1980 and 1996. This is to attempt to prevent the spread of mad cow disease (CJD). The FDA will allow blood donations from people who spent five years or more in Europe until October,31, 2002. I guess Great Britain is not in Europe. Top
NJ Shows Why People Don't Go to Physicians
New Jersey passed a law that requires insurers to pay for Pap smear and other similar tests. A state representative stated without comment that testing labs charge HMOs an average of $7.50 for each test but $70-$80 for those without insurance. Who gets more cancer of the cervix and are treated earlier, those with or without insurance? I guess it costs 10x more to do the test on someone without insurance. Top
CA Gov. Backs Law About Disputes
California Governor Davis is backing a bill that will require physicians and hospitals to continue to treat patients where the insurer has dropped the provider or vice versa. This continuation would be until the next annual sign up period. The plans would also be responsible for payment during this time. This law would only affect medical groups and not individual physicians. Top
CA Bill to Allow more Time for Seismic Fix Advances
A bill passed committee without a negative vote in delaying the seismic upgrade from 2008 to 2013. The law requires that the hospital would have to remain standing after a major quake and remain operational after a quake by 2030. Top
DISCLAIMER: Although this article is updated periodically, it reflects the author's point of view at the time of publication. Nothing in this article constitutes legal advice. Readers should consult with their own legal counsel before acting on any of the information presented.