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SGR Repeal Plea Backed by 110 Physician Groups
Here we go again:
More than 110 physician specialty and state medical society organizations this week renewed what has become an annual plea for Congress to repeal the sustainable growth rate formula.
If implemented according to schedule, the SGR will cut doctors’ Medicare pay 27%, leaving doctors with only 73 cents of every dollar the program pays them today starting on January 1, 2013.
The cost of repealing the SGR to restore those payments would be $245 billion over the next 10 years, according to August projections from the Congressional Budget Office.
See on www.healthleadersmedia.com
USDOJ – NJ: Former director of diagnostic testing center admits bribing doctors in cash-for-patients scheme
In the following post, note that the dollars involved are relatively modest:
The former executive director of Orange Community MRI LLC, today admitted paying bribes to doctors since April 2008 and agreed to forfeit $89,000 in proceeds from the crime, U.S. Attorney Paul J. Fishman announced.Chirag Patel, 37, of Warren, N.J., pleaded guilty to an Information charging him with one count of soliciting and receiving illegal cash kickbacks for patient referrals in violation of the federal health care anti-kickback statute.
According to documents filed in this case and statements made in court:
On Dec. 8, 2011, Patel was arrested and charged with offering and paying cash kickbacks to a New Jersey health care practitioner in exchange for referrals to Orange Community MRI. On Dec. 13, 2011, 13 New Jersey doctors and one nurse practitioner were arrested and charged in separate Complaints with accepting similar cash kickback payments from Orange MRI. Each of the defendants was recorded taking envelopes of cash in exchange for patient referrals.
Patel is the ninth person charged in the December 2011 takedown to plead guilty. Patel is the second member of Orange Community MRI to plead guilty; Ashokkumar Babaria, the former owner and medical director of Orange Community MRI, pleaded guilty on Sept. 27, 2012.
As part of his plea agreement, Patel agreed to forfeit $89,180 that constitutes criminal proceeds of the crime. As part of his guilty plea, Ashokkumar Babaria agreed to forfeit his revenues traceable to corrupt referrals, which the government has estimated could reach as much as $2 million. The seven health care providers that referred patients to Orange MRI who have plead guilty thus far have collectively agreed to forfeit over $150,000 in illegal kickbacks from Orange MRI.
See on www.justice.gov
For an aggregation of other articles on Hot Topics in Healthcare Law, go to my magazine on Scoop.it – Hot Topics in Healthcare Law and Regulation and my newspaper on Paper.li – Hot Topics in Healthcare Law.
For an aggregation of other articles on improving healthcare, go to my internet magazine Scoop.it! Changing Health for the Better.
USDOJ: Clinic Owners Plead Guilty in Detroit-Area Infusion Therapy Scheme
Two owners and operators of clinics that claimed to specialize in treating HIV and other conditions pleaded guilty today for their roles in an infusion therapy scheme carried out at two Detroit-area clinics that submitted millions of dollars in fraudulent claims to Medicare.
The guilty pleas were announced by Assistant Attorney General Lanny A. Breuer of the Department of Justice’s Criminal Division; U.S. Attorney Barbara L. McQuade of the Eastern District of Michigan; Special Agent in Charge Robert Foley III of the FBI’s Detroit Field Office; and Special Agent in Charge Lamont Pugh III of the HHS Office of Inspector General’s (HHS-OIG) Chicago Regional Office.
Raymond Arias, 40, and his wife, Emelitza Arias, 25, of Troy, Mich., each pleaded guilty, before U.S. District Judge Paul D. Borman of the Eastern District of Michigan, to one count of conspiracy to commit health care fraud. At sentencing, the defendants each face a maximum potential penalty of 10 years in prison and a $250,000 fine. Sentencing is currently scheduled for Feb. 12, 2013.
According to plea documents, Raymond Arias conceived of and oversaw fraud schemes at two clinics for which he was a beneficial owner: Elite Wellness LLC, and Carefirst Occupational & Rehabilitation Center Inc. He admitted to paying physicians to refer Medicare beneficiaries to Elite Wellness, and to purchasing Medicare beneficiary identifications for the purpose of submitting fraudulent claims to Medicare for expensive infusion therapy services that were not rendered as claimed by Carefirst.
According to court documents, Raymond Arias attempted to hide the Elite Wellness scheme from law enforcement by directing a nominee owner to assume control of the claims submitted and the bank account into which Medicare payments were deposited. After the nominee owner became involved, Raymond Arias and his alleged co-conspirators submitted approximately $10 million in claims over a 3-month period beginning in August 2010.
See on www.justice.gov
For an aggregation of other articles on Hot Topics in Healthcare Law, go to my magazine on Scoop.it – Hot Topics in Healthcare Law and Regulation and my newspaper on Paper.li – Hot Topics in Healthcare Law.
For an aggregation of other articles on improving healthcare, go to my internet magazine Scoop.it! Changing Health for the Better.
Modern Physician: Practice Makes Perfect: Preparing for shared-risk reimbursement models
In June, the MGMA-ACMPE released the results of a questionnaire that ranked members’ most-pressing practice management challenges. In this edition of “Practice Makes Perfect,” we’ll tackle No. 2 on that list: Preparing for reimbursement models that place a greater share of financial risk on the practice.
One of the many hot topics at our upcoming annual conference in San Antonio will be the changing healthcare environment and how practices can—and should—prepare for new payment methodologies. The federal government and commercial insurance companies are in the midst of changing the way they pay hospitals and doctors. Some of these changes are the result of the Patient Protection and Affordable Care Act as well as market forces. These changes will affect practices in all settings, and it’s important to prepare for reimbursement models that place a greater share of financial risk on the practice.
Physicians may soon be at financial risk as payers test and adopt new payment methods. The CMS and private insurers are proposing models to replace separate payments to hospitals, doctors and other providers with a single bundled payment, and we are seeing multiple definitions of bundling. A common type of bundled payment involves a single payment for all services furnished before, during and after a hospitalization, including outpatient diagnostic tests, inpatient facility costs, drugs, supplies and the professional services of every physician involved in the patient’s care.
In addition, the CMS and many insurers are testing variations on the capitation payment concept that was widely used in the health maintenance organization craze of the 1990s. Commonly referred to as “global payment,” this reimbursement method pays a set amount per patient (usually adjusted by demographics) and the provider accepts responsibility for a predetermined set of services regardless of the costs.
Both bundled and global payment reflects a sea change from the traditional fee-for-service payment system. Payers hope that bundled and global payments will create incentives for primary-care physicians, specialists and hospitals to better coordinate services and share accountability for the cost and quality of services. They hope the new payment systems will improve the care their beneficiaries receive while lowering the total cost of care by eliminating redundant services.
These new payment methods require doctors to think in new ways and will challenge the information systems of even the most sophisticated fee-for-service practice. Bundled and global payments change a practice’s profit calculation from emphasizing service volume to operating efficiency.
In this new payment environment, practices that gather the right information and provide high-quality, lower-cost care will be the most profitable.
See on home.modernphysician.com
For an aggregation of other articles on Hot Topics in Healthcare Law, go to my magazine on Scoop.it – Hot Topics in Healthcare Law and Regulation and my newspaper on Paper.li – Hot Topics in Healthcare Law.
For an aggregation of other articles on improving healthcare, go to my internet magazine Scoop.it! Changing Health for the Better.
Medical Homes Survey: Primary care with a personal touch – Modern Healthcare
Medical Homes Survey reveals diverse settings, but single goal: Increase quality of care.
When primary-care physicians needed to go somewhere new to revitalize their field, they found that there was no place quite like the patient-centered medical home: A practice model that emphasizes care coordination, increased access and enhanced doctor-patient communication—all with an emphasis on continuous quality improvement.
Modern Healthcare’s second annual Medical Homes Survey, conducted June 25-Sept. 28, drew responses from 29 organizations. The survey sample illustrates the wide variety of settings among the 4,870 sites that have been recognized as medical homes. One survey response came from an organization with a staff of 350 doctors, and another came from a solo practice. The largest group in the survey has an enrolled patient population of 939,000 while the smallest has 823. One thing they have in common is a desire to increase the quality of care by advancing an old-fashioned concept that is often enhanced by the newest technology.
See on home.modernhealthcare.com
For an aggregation of other articles on Hot Topics in Healthcare Law, go to my magazine on Scoop.it – Hot Topics in Healthcare Law and Regulation and my newspaper on Paper.li – Hot Topics in Healthcare Law.
For an aggregation of other articles on improving healthcare, go to my internet magazine Scoop.it! Changing Health for the Better.
Modern Physician: Lovelace Health acquires physician practice
Albuquerque-based Lovelace Health System has acquired Southwest Medical Associates, a physician practice that will retain its name, leadership and all 150 employees in the deal. No financial terms were disclosed, said a spokeswoman for Lovelace.
Effective immediately, the transaction starts a new physician model for Lovelace that will rely on a mix of employed, strategically aligned and community physicians.
See on home.modernphysician.com
For an aggregation of other articles on Hot Topics in Healthcare Law, go to my magazine on Scoop.it – Hot Topics in Healthcare Law and Regulation and my newspaper on Paper.li – Hot Topics in Healthcare Law.
For an aggregation of other articles on improving healthcare, go to my internet magazine Scoop.it! Changing Health for the Better.
Physician Associates to be bought by Orlando Health – Orlando Business Journal
According to the Orlando Business Journal: Physician Associates LLC has agreed to negotiate exclusively to be acquired by Orlando Health.
The details of the arrangement, including dollar value, have not been disclosed, but analysts spoken to for a story in August speculated the deal could be valued anywhere from $20 million to $60 million.
“Physician Associates LLC and Orlando Health today announced the physician practice has selected Orlando Health as the organization with which it will begin exclusive acquisition negotiations,” said Kena Lewis, Orlando Health spokeswoman.
Florida Hospital also was vying to buy the practice.
See on www.bizjournals.com
For an aggregation of other articles on Hot Topics in Healthcare Law, go to my magazine on Scoop.it – Hot Topics in Healthcare Law and Regulation and my newspaper on Paper.li – Hot Topics in Healthcare Law.
For an aggregation of other articles on improving healthcare, go to my internet magazine Scoop.it! Changing Health for the Better.
Former Indiana surgeon nabbed in Italy gets 7 years in prison
A former Indiana surgeon arrested on a snowy Italian mountainside after five years on the run was handed a stiff prison term Friday for billing insurers and patients for procedures he didn’t perform, with the federal judge saying he used patients like an ATM machine.
See on www.foxnews.com
USDOJ: Medicare Fraud Strike Force Charges 91 Individuals for Approximately $430 Million in False Billing
Medicare Fraud Strike Force operations in seven cities have led to charges against 91 individuals – including doctors, nurses and other licensed medical professionals – for their alleged participation in Medicare fraud schemes involving approximately $429.2 million in false billing, Attorney General Eric Holder and Health and Human Services (HHS) Secretary Kathleen Sebelius announced today.
Attorney General Holder and Secretary Sebelius were joined in the announcement of the nationwide takedown by Assistant Attorney General Lanny A. Breuer of the Justice Department’s Criminal Division, FBI Associate Deputy Director Kevin Perkins, Inspector General Daniel R. Levinson of the HHS Office of Inspector General (HHS-OIG) and Dr. Peter Budetti, Deputy Administrator for Program Integrity of the Centers for Medicare and Medicaid Services (CMS).
“Today’s enforcement actions reveal an alarming and unacceptable trend of individuals attempting to exploit federal health care programs to steal billions in taxpayer dollars for personal gain,” said Attorney General Holder. “Such activities not only siphon precious taxpayer resources, drive up health care costs, and jeopardize the strength of the Medicare program – they also disproportionately victimize the most vulnerable members of society, including elderly, disabled and impoverished Americans.”
“Today’s arrests put criminals on notice that we are cracking down hard on people who want to steal from Medicare,” said HHS Secretary Sebelius. “The health care law gives us new tools to better fight fraud and make Medicare stronger. In addition to the arrests made today, HHS used new authority from the health care law to stop future payments to many of the health care providers suspected of fraud, saving Medicare resources and taxpayer dollars from being lost to fraud in the first place.”
See on www.justice.gov
For an aggregation of other articles on Hot Topics in Healthcare Law, go to my magazine on Scoop.it – Hot Topics in Healthcare Law and Regulation and my newspaper on Paper.li – Hot Topics in Healthcare Law.
For an aggregation of other articles on improving healthcare, go to my internet magazine Scoop.it! Changing Health for the Better.
Park Nicollet’s experiment with ACOs – TwinCities.com
In 2005, Park Nicollet Health Services started participating in a pilot project that was the first to test the idea of “accountable care organizations” in the federal Medicare program.
Called the Physician Group Practice Demonstration Program, Park Nicollet was one of 10 large multi-specialty groups across the country that agreed to adopt a new payment relationship from Medicare for a portion of its patients.
The premise was straightforward: If Park Nicollet and other groups could provide care at a lower cost while meeting quality standards for patients, the groups would share the savings with Medicare.
But as a study published this month in the Journal of the American Medical Association shows, results from the Physician Group Practice, or PGP, project have been mixed. Overall, researchers found that the five-year pilot delivered only modest savings, although savings were larger for a subset of patients, many of whom have complex health problems.
“(Park Nicollet) received a bonus payment in only one year of the PGP,” said Carrie Colla, a researcher with the Dartmouth Institute for Health Policy and Clinical Practice. “But in the (subset), they saved quite a bit of money.”
Improving care while lowering costs for complex patients is one of the key challenges facing the nation’s health care system, said Dr. David Abelson, the chief executive officer at St. Louis Park-based Park Nicollet, during an August 2011 interview about the pilot project.
See on www.twincities.com
For an aggregation of other articles on Hot Topics in Healthcare Law, go to my magazine on Scoop.it – Hot Topics in Healthcare Law and Regulation and my newspaper on Paper.li – Hot Topics in Healthcare Law.
For an aggregation of other articles on improving healthcare, go to my internet magazine Scoop.it! Changing Health for the Better.
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