Archive for January, 2015

$2.25 Million Settlement for Unnecessary Angioplasties

Tuesday, January 6th, 2015

United States ex rel. Carroll v. Adventist Health Systems, et al., Case No. CV-10-4925 DMR

A settlement in the amount of $2,250,000, payable by St. Helena Hospital, to the United States, stems from allegations that it submitted false claims to Medicare for certain cardiac procedures and related inpatient submissions.

Former employee of St. Helena Hospital, Kacie Carroll, filed the qui tam action in the U.S. District Court for the Northern District of California. Carroll will receive $450,000.

During the period from 1/1/2008 through 7/31/2011, it was alleged, that St. Helena Hospital knowingly charged Medicare for medically unnecessary percutaneous coronary interventions, more commonly known as angioplasty, the surgery performed to open narrowed or blocked blood vessels that supply blood to the heart. In addition, it was also alleged that the hospital unnecessarily admitted angioplasty patients who should have been treated on a less costly, outpatient basis.

Prescriptions for Controlled Substances to Medicare Patients is on the Rise

Tuesday, January 6th, 2015

Even as the abuse of prescription drugs has escalated and the national crackdown on it has occurred, new data suggests that doctors are prescribing even larger numbers of prescriptions for the most potent controlled substances to Medicare patients.

And, along with the increase in the number of prescriptions written, physicians are under increased scrutiny, as well as facing disciplinary action. Twelve of Medicare’s top 20 prescribers of Schedule 2 drugs (those that include powerful narcotic painkillers and stimulants with the highest potential for abuse and dependence) have faced disciplinary actions by their state medical boards or criminal charges related to their medical practices.

The most recent year for which data is available, 2012, Medicare covered nearly 27 million prescriptions for Schedule 2 controlled substances. Within the past year, Medicare has started to use prescribing data to identify potentially problematic doctors, as have some state medical boards as well. Beginning in mid-2015, Medicare will have the authority to kick doctors out of the program if they prescribe in abusive ways.