Medicare Compliance & Reimbursement

Revamping this safety net protects patients and the hospital's reputation and compliance record. Hospitals can sidestep a major patient safety and compliance nightmare: A physician who's been doing procedures that clearly don't meet established medical necessity criteria. That scenario occurred recently at a Baltimore,Maryland hospital where a surgeon stands accused of planting stents in people who didn't need them (see the cover story in the last issue of Medicare Compliance & Reimbursement, Vol. 33, No. 1). "In terms of surgical procedures, the No. 1 safety measure [to help prevent unnecessary procedures] is peer review in hospitals," says attorney Christopher Lucas, in private practice in Camp Hill, Pa. "The hospital has access to the experts and diagnostic data and could evaluate medical necessity, although sometimes the hospital has financial incentives not to look at thatissue too closely." Not only can the bottom line skew the peer review committee's findings or willingness [...]