Physician Practice Roundup—Doctor gets 5 years in prison for operating 2 ‘pill mills,’ plus more news

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A doctor will spend time in jail for running two "pill mills" in Maryland. (Pixabay)

Doctor gets 5 years in prison for operating two ‘pill mills’

A Maryland doctor was sentenced to five years in prison for operating two “pill mills” that were disguised as wellness centers.

Kofi Shaw-Taylor, a urologist, was sentenced to two, five-year concurrent sentences after he pled guilty to a charge of Medicaid fraud and conspiracy to commit Medicaid fraud. He was also ordered to pay $118,077 in restitution to the Maryland Medicaid program.

Prosecutors said he was part of a scheme to operate two pill mills in Baltimore City and Anne Arundel County. His sentencing ends an investigation of illegal opioid distribution that resulted in the conviction of 10 defendants. According to evidence against him, Shaw-Taylor owned or operated two clinics where patients received large quantities of narcotics including oxycodone, morphine, tramadol, and benzodiazepines in exchange for cash. (Maryland Attorney General Office statement (PDF))

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CMS missed deadline to create MACRA-mandated chiropractic preauthorizations, GAO says

The Centers for Medicare & Medicaid Services (CMS) failed to meet a deadline required under the Medicare Access and CHIP Reauthorization Act (MACRA), according to a recently released report (PDF) from the Government Accountability Office (GAO).

CMS was supposed to implement a process for reviewing prior authorizations for chiropractic services billed to Medicare by Jan. 1, 2017; however, it still has not established that process, the watchdog agency says.

Chiropractic services have a disproportionately high rate of improper payments, the report explains. Of the $700 billion CMS spent on healthcare for Medicare beneficiaries in fiscal year 2016, only $540 million—less than 1%—went toward chiropractic services. However, the improper payment rate that year was 46%, compared to 9.7% overall (PDF). CMS attributed most improper payments to insufficient or incorrect documentation. (FierceHealthcare)

Survival increases for female heart attack patients when treated by a woman doctor

A new study found that women survive a heart attack more often when the doctor treating them is female.

The study, published in the Proceedings of the National Academy of Sciences, examined a census of heart attack patients admitted to Florida hospitals between 1991 and 2010 and found higher mortality rates among female patients who were treated by male physicians. However, mortality rates decreased when male physicians in the emergency room practiced with more female colleagues or had treated more female patients in the past. (PNAS study)

Beaumont Hospital agrees to pay $84.5M for anti-kickback violations

A Detroit-area health system agreed to pay $84.5 million to settle accusations that it made improper payments to referring physicians.

The Justice Department announced that Beaumont Health agreed to settle the allegations that its William Beaumont Hospital ran afoul of the anti-kickback statute between 2004 and 2012. That law bars hospitals from paying or receiving payments to induce referrals for services covered under the Medicaid or Medicare programs. Officials also alleged that the health system broke the physician's self-referral law, or the Stark Law, which blocks hospitals from billing Medicare for certain services referred by physicians with whom the hospital has an improper financial arrangement. (FierceHealthcare)

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