Part B Insider (Multispecialty) Coding Alert

Published on Sun May 28, 2006 PDF

Doctor prescribed Oxycontin to random patients, gets 150 months

If you didn’t think Stark self-referral and anti-kickback claims were serious business, a recent settlement by Clearwater, FL-based Lincare should make you think again.

Lincare agreed to repay $12 million, including $10 million to the HHS Office of Inspector General, to settle several Stark and kickback cases. Lincare didn’t admit any wrongdoing. The OIG says this is the largest settlement it’s ever achieved. Meanwhile, Tenet Healthcare will pay $21 million to settle allegations that Alvarado Hospital Medical Center paid illegal kickbacks to physicians who relocated to the area. Tenet agreed to sell or close Alvarado.

• West Palm Beach pain management doctor Andrew Weiss will serve a whopping 150 months in prison after he pled guilty to four counts of prescribing Oxycontin to patients who didn’t need it, or who weren’t even his patients, the U.S. Attorney for the Southern District of Florida announced.

• Hyannis, MA cardiologist Philip Chiotellis will repay $1.9 million to settle claims he submitted fraudulent bills to the Medicare program. He allegedly billed for cardiovascular stress tests when he only performed lower-paying cardiac rehabilitation services. He only billed the codes that Medicare reps recommended, his attorney, Thomas Crane, told the Cape Cod Times. “He always had his staff check with Medicare, and now they say this is the wrong code,” said Crane.

• Watch out: Your physician may see more denials for high-cost procedures and high-level visits for chronic patients in the future, as policymakers search for ways to bring down spending in higher-cost locations. Medicare pays three times as much to treat chronically ill patients in one hospital as it pays in another nearby hospital, according to the newest publication from the Dartmouth Atlas Project at Dartmouth Medical School. And the extra spending doesn’t mean patients live longer or stay healthier, Dartmouth says.

• The House of Representatives passed a 2007 budget resolution that didn’t include any Medicare cuts, following the Senate’s lead. But the budget also didn’t include any money to rescue physicians from next year’s 4.6 percent cut.

• It only took 273 days to develop a new National Coverage Determination under the new process, which took effect in 2004, according to a report to Congress by the Centers for Medicare & Medicaid Services. Before that, it took 370 days for NCDs in 2004, and 460 days for NCDs in 2003.