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Week in Review

by Kroger Burrus on March 19th, 2013

Kroger | Burrus Week in Review


USA v. Read
An ambulance company’s owners were convicted of health care fraud for encouraging EMTs to omit patients’ mobility status from records. Medicare pays more for the transportation of patients with poor mobility and jurors found that 4 out of 15 patients considered did not have a medical necessity justifying the amounts billed to Medicare. Jurors assessed a fine in the amount the company overbilled for four patients, while the district court determined that the defendants owed an additional $1.7 million representing the total amount billed for all 15 patients. On appeal, the 5th Circuit held the trial court could permissibly consider the total amount billed for all 15 in spite of the jury reaching a verdict on only four of the patients whose bills were challenged.


Texas Hospital Agrees to $2.5 Million Settlement in Billing Case
A South Texas children’s hospital and a nearby radiology center have agreed to pay $2.3 million to settle whistle-blower allegations alleging they double-billed government health care programs for work on genetic ultrasounds.

Kidney Recipient Killed by Rabies Infection
A kidney transplant recipient has died after contracting rabies from the transplanted organ. Federal officials have identified three other people who received organs from the same donor and these individuals have been treated with rabies vaccinations.

Study Finds Pre-Op Tests Frequently Unnecessary
A study of elective hernia repairs found that 2/3 of patients had preoperative laboratory tests performed and these tests did not predict complications in patients without comorbidities. The study’s authors estimate that pre-operative testing costs up to $18 billion and have recommended that surgical societies establish guidelines to reduce unnecessary testing.

Caesarian Delivery Rates Vary Widely Among US Hospitals
Caesarian delivery rates vary from 7.1% to 69.9% among US hospitals and the overall trend is an increase in cesarean deliveries. The authors of a recent study on cesarean rates note that Medicaid pays for half the births in the US and government efforts to decrease overuse of this procedure may be warranted.

Hospitals Responding to Angry Doctors
Doctors’ aggressive conduct has long been tolerated as a product of a stressful environment, but in recent years the Joint Commission has called for a “zero tolerance” approach toward disruptive behavior. Some hospitals have responded to this issue by requiring anger management courses for their most distressed physicians to improve morale and patient safety.

‘Texas Solution’ to Medicaid Expansion Considered
Lawmakers in Austin are considering a “Texas solution” to Medicaid reform that would allow the state to access billions of federal dollars to help finance Medicaid expansion. One proposal calls for personal responsibility of Medicaid recipients through implementation of copayments or deductibles.

Medicaid Pay Raise for Doctors Delayed
A 73% pay raise for doctors promised as part of the Affordable Care Act is three months behind schedule and may not be implemented for another three months, according to state Medicaid directors. The Obama administration has stated that the payments will be made eventually and will be made retroactive to January 1, 2013.

Patients Do Not Want to Weight Health Care Costs
A study of patient’s attitudes regarding health care costs found that most do not want to weigh the costs borne by insurers and many feel motivated to choose a more expensive but equally effective option out of spite toward insurance companies.

CMS Revises Hospital Readmission Penalties
CMS has revised readmission penalties for hospitals for a second time. Penalties based on the readmission of cardiac patients and pneumonia patients readmitted between 2008 and 2011 were assessed last August and revised in September after errors were discovered. CMS has revised these penalties again after discovering that it failed to include all Medicare inpatient claims in its calculations.

Physician Gender Not Linked to Health Care Costs or Outcomes
A recent study found that a physician’s gender has no bearing on patients’ outcomes or use of health care resources. This study contradicts an earlier, smaller study that associated female providers with lower use of health-care services and costs.

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