PHYSICIAN WHO DEFRAUDED AUTO INSURER ISN’T ENTITLED TO ARBITRATION

Over a four-year period Dr. Mun billed Allstate $500,000 for supposed “electrodiagnostic testing” of auto accident victims.  Allstate paid the claims as they came in.  About ten months after the last of the alleged tests, Allstate sued the doctor in federal court, alleging that the billing was fraudulent and …

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CMS PROPOSES HIKE IN HOSPICE PAYMENTS, SEEKS INPUT ON DEFINITIONS

In an announcement scheduled for Federal Register publication on May 8, CMS proposes a 1.3% increase in hospice payments for fiscal year 2015. The increase, which would amount to $230 compared to fiscal year 2014, may not look like a lot, but any increase is meaningful at a time when CMS is working hard to lower …

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MEDICARE PANEL VOTES AGAINST ANNUAL CT SCANS FOR HEAVY SMOKERS

Yesterday a Medicare panel surprised many in the medical community by recommending against Medicare coverage of annual CT scans for current or former heavy smokers.  The nonbinding recommendation was issued by CMS’s nine-member Medicare Evidence Development & Coverage Advisory Committee. The vote comes …

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PHYSICIAN MUST PAY HOSPITAL’S $730,000 LEGAL BILL

Last Monday the Tenth Circuit socked a heart surgeon with a $733,000 legal bill for his challenge of a Tulsa hospital’s termination of his practice privileges.  The twist is that it’s a bill for the hospital’s lawyers—not the physician’s.  He was already on the hook for those. Heart surgeon George …

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SIXTH CIRCUIT KNOCKS DOWN HAIL MARY PASS

Usually it’s the play-by-play announcer—not the scorekeeper— calling it a Hail Mary pass, and what he means is that it’s a desperate, pretty-near hopeless, last-ditch effort.  So yesterday when the Sixth Circuit Court used the term to describe a ProMedica argument, it was clear that the FTC had won the …

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CHILDREN’S HOSPITAL SETTLES WHISTLEBLOWER CASE FOR $7 MILLION

Yet another hospital has paid millions to settle a whistleblower suit brought by a former insider.  For over a decade Barbara Schubert worked for the physician-recruiting subsidiary of All Children’s Health System.  She became a whistleblower, claiming that All Children’s Hospital, also a subsidiary of the …

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