Part B Insider (Multispecialty) Coding Alert

Published on Mon Jan 01, 2007 PDF

Is your doctor working well with others?

When it comes to preventing future problems and treating chronic ailments, individual practice associations lag behind integrated medical groups, a new study says.

The close collaboration and centralized decision making in integrated medical groups may be behind the better quality of care, according to the study, -Do Integrated Medical Groups Provide Higher-Quality Medical Care than Individual Practice Associations?- The study appeared in the Annals of Internal Medicine.

In a related Health Affairs article, researchers say heart-attack patients don't fare as well when receiving treatment from a solo physician practice as opposed to a larger practice.

Studying more than 116,000 patients- records, researchers from Arizona State University discovered that heart-attack patients receiving treatment from attending solo practitioners were less likely to have cardiac catheterization and angioplasty within 24 hours of a hospital admission and more likely to die than other patients in the same hospital, the article says.

One-day angioplasty rates for larger physician practice's patients were 10 to 26 percent higher and one-day catheterization rates were 10 to 12 percent higher than patients attended by physicians from solo practices, the researchers reveal.

In other news:

- The Centers for Medicare & Medicaid Services awarded a contract for its electronic data center (EDC) for claims processing to Companion Data Services, a subsidiary of Blue Cross Blue Shield of South Carolina, and Electronic Data Systems.

- Miami appears to be ground zero for health care fraud prosecutions right now. A jury found physician Frantz Achille guilty of conspiracy and health care fraud. Achille was a physician at two Miami HIV/AIDS clinics and allegedly forged medical paperwork to receive $2.1 million from Medicare. Patients either never needed the expensive treatments or never received them. The clinic paid patients a kickback to show up, prosecutors said.

Also, Miami physician Julian Torres was arrested Jan. 30, charged with conspiracy and other federal crimes. The owners of Carob Medical Services allegedly paid $20,000 in kickbacks to Torrez to prescribe medical equipment for patients who didn't need it. Carob received around $1 million from Medicare for this equipment.

Finally, Diana Sotto, owner of All Medical Billing Systems, was sentenced to 10 years- imprisonment, followed by three years- supervised release. She helped Miami clinic Project New Hope defraud Medicare of more than $2.8 million from Sept. 2004 to Sept. 2005, billing for HIV/ AIDS medications for patients who actually were HIV-positive but didn't receive the medication.