Tuesday, December 27, 2011

More Medi$cams?

While we've spent a lot of time talking about the so-called "Doc Fix," it appears that perhaps we need to "Fix Doc," as well:

"California-based Prime Healthcare Services buys financially troubled hospitals and turns them around ... She says Reddy told doctors how to diagnose patients he had never seen."


Now, one may argue that this is simply a game between how Medicare reimburses depending on how a procedure is coded, but:

"He encouraged the physicians to stop documenting syncope, which is fainting or dizzy spell, and instead use the term autonomic nerve dysfunction, which reimburses at a higher rate."

But here's where the story takes an odd twist:

"The Federal Bureau of Investigation (FBI) is looking into the billing practices of ... Prime Healthcare Services, following reports that it allegedly overbilled Medicare for rare and serious conditions at high rates"

I find this odd because one would think that this falls under the purview of HHS Secretary Shecantbeserious, not J Edgar Hoover. It's true that the FBI has been involved with the Maxim Healthcare case, but that's in addition to HHS and related agencies.

In fairness, we haven't heard Prime's side of the story, nor do we know just how wide-spread the (alleged) practice is. One wonders whether this is the tip of an iceberg, or common business practice. As we saw in the LabCorp case, what HHS calls "fraud" may really be nothing more than breaking arbitrarily-set rules.

[Hat Tip: FoIB Holly R]
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