Archive for February, 2011

Medicare Fraud Strike Force

February 17, 2011 Leave a comment

Yesterday we were informed of 20 indictments in Miami.

Today, we have been infored that the Medicare Fraud Strike Force has charged 111 individuals all over the country with more than $225 million in false billing.


Tomorrow?  Who knows what tomorrow brings.

We do know this — these people in the Medicare Fraud Strike Force are on a mission.  911 and terrorists may have provided a momentary distraction from President Clinton’s Operation Restore Trust.  But not any longer. 

Remind your healthcare clients that “everyone is doing it” is no defense (and isn’t true) — after all, “everyone” includes the 131 persons who were caught.

Categories: Fraud and Abuse

Alternatives for Physicians

February 13, 2011 2 comments

Physician practices are dealing with increased demands from the government, from managed care companies, from employers, and from patients to provide higher quality and better access to health care at cheaper costs.  While these demands existed before health law reform, health law reform has exacerbated the pressures and the uncertainties on physicians and their advisors.  Most of the alternatives for responding to these demands have been around for some time, but the need for more decisive action has greatly intensified.  Some of the intensity is artificial, fueled by the fear of being left behind.  In some cases, it is too early to do anything, because so much is still in flux.   Newspapers, magazines, professional websites, and blogs are reporting on these issues more and more.  This is likely to add to the confusion of what to do and when to do it.

Nevertheless, neither opportunities nor threats can be ignored.  Physicians and their advisors must be alert and be prepared to act when the time is appropriate.  Premature action may be as hurtful as delay.  Staying informed is critical.

Here is a list of practice alternatives that I am seeing, and my physician clients are experiencing (and, in some cases, adopting).  The list is not meant to be exhaustive, and I would like to hear what any of you or your clients are experiencing in this time of professional, economic, and legal uncertainty.

  • Internal improvement of practice management — e.g., better billing and collection procedures, adoption of EHRs, employing more skilled administrative support staff
  • Expansion of healthcare services being offered — e.g., adding nontraditional healthcare services, employing specialists
  • Engaging outside practice management companies
  • Consolidation/merger of solo and small practices with larger, same specialty practice groups
  • Consolidation/merger/affiliation with multi-specialty practice groups
  • Affiliation with IPAs, PHOs, and now ACOs
  • Sale of practice to national practice management, single specialty, and multi-specialty corporations
  • Sale to, affiliation with, or employment by hospital organizations
  • Opting out of Medicare and managed care plans and establishing a concierge practice for selected patients

Over the next several postings, I will review these alternatives and discuss the issues involved.


February 6, 2011 Leave a comment

The recent Federal District Court holding that Obamacare is unconstitutional is another distraction to the real problem, which is, in case it has been drowned out by all of the static, how to improve health care for Americans in the context of the current economic situation.

I do not see how the issues of health care and health care reform can be solved without a shared view of our priorities.

What is the correct balance between entitlement programs directed to the elderly, disabled, and poor Americans, including the newly poor, unemployed, and uninsured, on the one hand, and a crippling federal debt, fighting wars to protect our security, and increasingly economically strapped individuals, businesses, cities, and states, on the other.  Is access to health care a right?  Is it more important than education, security, or economic and social freedom?

All these things are important to us as Americans.

So, what do we do first?  In my opinion, we must do two seemingly incompatible things simultaneously — improve the quality of the care given (that includes allowing more creative and alternative modalities and providing more preventive care free of insurmountable regulatory obstacles) and reduce the overall costs of the care (that includes eliminating unnecessary, defensive, and fraudulent care).

We cannot talk about how much we should spend on health care without knowing how much it actually costs.

Obamacare is sensitive to these issues, but, at the same time, it is insensitive to the regulatory and economic burdens it places on Americans.

How do we talk about priorities in health care?  We start with answering the question of “What would an ideal designed-from-the-ground-up health care delivery system look like?”  If we don’t even try to understand what the ideal is, how can we know how to rank our priorities?  In the endless process of legislating and adopting regulations, and incessant political bickering, has anyone taken the time to think about the question of how should health care delivery work in America?  That would be a good place for a bipartisan effort.

This is not hopeless.  Americans are finding ways to address our health care crisis on their own.  Read the article, “The Hot Spotters,” by Dr. Atul Gawande in the January 24th issue of The New Yorker.  President Obama is correct when he says “Yes, we can!”  He is also correct when he said in his remarks on the State of the Union last month that “We do big things” in America.

It’s time.

%d bloggers like this: