Physician Practice Roundup—Doctors get their say on proposed physician fee schedule; Doctor gets 12 years in prison for role in $155M Medicare fraud

Young female doctor sitting at desk in front of computer covering face with hand in frustration
There's a lot doctors don't like in CMS' proposed physician fee schedule. (Getty Images/PRImageFactory)

Doctors get their say on proposed physician fee schedule

Physician groups are speaking out about CMS’ proposed rule for the 2019 Medicare physician fee schedule. The comment period on the 1,473-page proposed rule—which outlines the fee schedule and changes for year three of the physician payment program implemented under MACRA—ends Sept. 10.

Yesterday, the American Academy of Family Physicians added its comments about the controversial proposal.

While the AAFP said it appreciated CMS’ efforts to reduce the administrative burden on doctors, it concluded changes in the proposal would have “a net-negative impact” on family medicine practices, particularly independent practices. The AAFP outlined its concerns about the proposed rule in a 92-page letter (PDF) to CMS.

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A proposal to pay physicians less for some Medicare patients’ complex office visits by consolidating evaluation and management (E/M) codes has drawn particular criticism from both doctor and patient groups. (AAFP letter)

Doctor gets 12 years in prison for role in $155M Medicare fraud

A judge sentenced a Houston psychiatrist to more than 12 years in prison for his role in a $155 million Medicare fraud scheme.

Riyaz Mazcuri, M.D., 67, a former attending psychiatrist at Riverside General Hospital in Houston, was sentenced in the scheme that involved false and fraudulent claims for psychiatric services, according the U.S. Department of Justice. He was also ordered to pay over $20.6 million in restitution to Medicare and more than $2.2 million to Medicaid.

He was found guilty by a jury of one count of conspiracy to commit healthcare fraud and five counts of healthcare fraud after a five-day trial last May. To date, 15 others have been convicted of offenses based on their roles in the fraud, submitting claims to Medicare, through Riverside, for approximately $155 million in false and fraudulent claims for partial hospitalization program services—a form of intensive outpatient treatment for patients with severe mental illness. (DOJ announcement)

UnitedHealthcare and AMA clash over Medicare's step therapy changes

A recent policy change that would allow Medicare Advantage plans to use step therapy for Medicare Part B drugs is creating yet another dividing line between insurers and providers.

UnitedHealthcare—the nation’s largest Medicare Advantage carrier, with a prominent voice in the ears of federal officials—says new regulations around step therapy will give payers the flexibility to bring down drug costs for Medicare Part B beneficiaries by nurturing a burgeoning biosimilars market.

Meanwhile, the American Medical Association (AMA) is worried the new policy—which serves as a type of prior authorization requiring patients to try a less-expensive option before graduating to a higher cost brand name drug—will lead to “unnecessary red tape” and that patients will see more denials as a result of the new policy. (FierceHealthcare)

One medical school drops honor society nominations

The Icahn School of Medicine at Mount Sinai in New York City has placed a moratorium on student nominations to the honor society Alpha Omega Alpha, saying the selection process discriminates against students of color, according to an NPR report.

The school made the change after a group of students organized to fight inequality at Icahn. Election to the honor society is one of the highest academic awards medical students can receive and one that can help students compete for residency programs and jobs.

The award is generally open to the top 25% of a medical school’s graduating class. While about 18% to 20% of graduating classes at Icahn are from a racial background underrepresented in medicine, including blacks and Latinos, over the past five years only around 3% of students chosen for honor society members were from those groups. (NPR article)

Another doctor agrees to plead guilty in kickback scheme

A third doctor has agreed to plead guilty in a kickback scheme at the now-bankrupt Forest Park Medical Center in Dallas, according to the Dallas News.

David Daesung Kim, M.D., 55, a Colleyville bariatric surgeon, agreed to plead guilty to accepting kickbacks in exchange for referring patients to the medical center, the newspaper said. He is the eighth defendant in the case that has entered a guilty plea, including two other physicians. Kim received about $4.5 million in kickbacks between 2009 and 2012 for bringing patients to the medical center for surgery, according to court documents. (Dallas News article)