This is a review of claim facts and corrective actions taken for excisional debridements (complex review, incorrect coding), one of the top five overpaid services in inpatient hospitals, as explained in CMS's recovery audit contractor evaluation report.
Legal & Regulatory Issues
Citing "concerns about physicians responding to incentive payment and shared savings programs by stinting, cherry picking, steering and making quicker-sicker discharges," CMS has proposed a self-referral exception for such incentive and gain-sharing programs aimed at preventing these potential issues while…
The Joint Commission's board of commissioners approved the continued engagement of its implementation task force on the revision of medical staff standard MS.1.20. The Board also suspended the planned July 2009 implementation date for the current revised standard.
The Minnesota Court of Appeals has upheld an injunction preventing a hospital from disciplining one of its physicians after finding that the hospital’s peer-review process leading to the discipline of the physician was performed with malice and repeatedly violated the…
Congressional Democrats have been pushing curbs on physician-owned hospitals as a way to contain Medicare costs, but lobbyist efforts are carving out exemptions for some facilities, reports the N.Y. Times in a story not very favorable to physician-ownership and specialty…
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A New Orleans Hospital, Touro Infirmary, will pay $1.75 million to settle allegations that it submitted false Medicare claims, according to the Department of Justice (DOJ). The DOJ alleges Touro made unlawful payments of almost $150,000 annually, from 2000 to…
While there has been no new movement on the Supplemental Appropriations Bill, which contains language that would effectively ban future physician-owned hospitals and cap expansion of existing ones, this week, a House version is expected to pass soon, according to…
Three diagnostic imaging groups in Portland, Ore., failed to show that a health system, health plan and preferred provider organization in the state conspired to monopolize the diagnostic imaging market, a federal appeals court has ruled.
A Louisiana hospital did not have a duty to disclose an anesthesiologist's drug problem in a reference to a prospective hospital employer, and therefore cannot be held liable for patient injuries the impaired physician subsequently caused at the new hospital,…
New requirements of initial self-disclosure of Medicare or Medicaid fraud have been issued by the Department of Health and Human Services Inspector General Daniel Levinson in an open letter. The fuller disclosure to the Office of Inspector General will be…