Physician Practice Roundup—Florida surgeon part of $1.5M resolution of alleged kickback scheme

Florida surgeon part of $1.5M resolution of alleged kickback scheme

An Orlando-area orthopedic surgeon was part of an agreement to pay $1.5 million to resolve allegations of an illegal kickback and patient referral scheme, according to the U.S. Attorney’s Office for the middle district of Florida.

Kenneth Krumins, M.D., agreed to pay $500,000 as his share of the settlement. Conway Lakes NC, LLC—an Orlando skilled nursing facility—and other related parties agreed to pay the remaining $1 million to resolve allegations that they engaged in a kickback scheme related to the referral of Medicare and TRICARE patients.

Conway Lakes conspired to pay Krumins under a sham medical director agreement to illegally refer patients to the facility for rehabilitation services that were billed to the U.S. government, the U.S. attorney’s office said. The settlement agreement also resolved allegations that Krumins engaged in a similar kickback scheme with a related home health agency. (U.S. Attorney’s office announcement)

Big increase in benzodiazepine prescribing by primary care doctors

Doctors—particularly primary care physicians—are writing many more prescriptions for benzodiazepines, a drug implicated in a growing number of overdose-related deaths, according to a study published in JAMA Network Open.

The percentage of ambulatory care visits that led to a benzodiazepine prescription almost doubled from 2003 to 2015 from 3.8% to 7.4%, according to the study. Primary care doctors wrote about half of those prescriptions. As well as an increase in prescriptions, researchers also found co-prescribing with other sedating medications. The study found benzodiazepine use rose substantially for indications other than anxiety and insomnia, including prescriptions to treat back pain and other types of chronic pain.

In light of increasing death rates associated with benzodiazepine overdose, addressing prescribing patterns may help curb the growing use of benzodiazepine, the researchers said. (JAMA Network Open study)

Moving beyond medical errors: How EHRs are 'nudging' practices to change certain behaviors

Electronic health records (EHRs) are usually cited for their ability to help diagnose diseases and reduce medical errors. But several health systems are testing how EHRs can be used to target other factors, like patient comfort and drug shortages.

Since EHRs are frequently used to guide patient care, adjusting the output of those systems can have considerable impact on patients—beyond just their immediate health condition.

Consider the University of Chicago Medical Center, which has been experimenting with a study module called SIESTA (Sleep for Inpatients: Empowering Staff to Act) to help patients in hospitals sleep better. The study is aimed at reducing nighttime awakenings for inpatients so they don't experience in-hospital sleep deprivation.

Inpatient sleep deprivation occurs when EHRs prompt doctors and nurses to take vital signs, administer medication or perform a test irrespective of the time of day. If a patient is being consistently woken up this way, they can suffer grogginess, delirium and falls. (FierceHealthcare)

Patients on Medicaid still face a host of barriers to accessing medication-assisted treatment (MAT), a panel of experts told the Medicaid and CHIP Payment and Access Commission (MACPAC) on Friday. 

Barriers blocking access to MAT for patients on Medicaid include everything from limits placed on doctors for prescribing MAT drugs because they can be diverted for misuse and illicit use, as well as long wait times for prescriber appointments and cash-only clinics, the experts told MACPAC, which is charged with advising Congress on Medicaid programs. 

Other problems include gaps in treatment between coverage transitions and emergency departments that are not regularly staffed with buprenorphine prescribers and are not able to help patients presenting for treatment, said Kristin Hoover, who is the clinical pharmacy manager for the Pennsylvania Department of Human Services Office of Medical Assistance Programs.

"It is unfortunate that it is easier for prescribers to write prescriptions for opioids than it is for prescribers to write prescriptions for buprenorphine MAT," Hoover said. (FierceHealthcare)