Physician Practice Roundup—Practice settles $400K improper billing case

Male doctor in white lab coat
Billing issues cost a Maryland practice $400,000. (Getty/Saklakova)

Practice settles $400,000 improper billing case

A Maryland cardiac practice has agreed to pay the federal government almost $400,000 to settle False Claims Act allegations relating to improper billing.

Cardiac Associates, P.C., agreed to pay the money to settle accusations that it submitted medical claims to the government for services that were not provided, according to an announcement from the U.S. Attorney’s Office for the District of Maryland. The medical practice, which has offices in four Maryland locations, was accused of charging the government twice for a single test.

According to the settlement agreement, the government contends that from January 2012 through December 2016, Cardiac Associates billed Medicare and Medicaid for two similar procedures on the same date for the same patient, when only one of the procedures was actually performed. The government said the practice performed a doppler duplex examination and billed under one CPT code for the test. The practice then billed for an additional test using another CPT code, which references an older, different technology, one that has generally been replaced by the newer technology. The government contended that billing both CPT codes was improper and led to the submission of false claims. The settlement is not an admission of liability by the practice. (U.S. Attorney’s office announcement)

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Washington University in St. Louis to provide free or reduced tuition to most of its medical students

The Washington University School of Medicine in St. Louis has committed $100 million over the next decade which will allow it to provide free or reduced tuition to the majority of its incoming students.

The funds will allow as many as half of the school’s future students to attend tuition-free and many others to receive partial tuition support, according to a university announcement. The funds will also support current efforts to enhance and modernize the school’s medical education program.

The scholarship program will begin with the 2019–2020 entering class. The school said the investment aims to reduce concerns about medical school debt while attracting highly qualified students from diverse backgrounds.

The announcement comes as other medical schools are also trying to minimize student debt, including New York University which is offering free tuition for all current and future students, and Kaiser Permanente, which will offer free tuition for the first five graduating classes at its new medical school. (University announcement)

Primary care studies get short shrift by federal research institute, study finds

Despite the fact that a majority of patients in the U.S. receive care in primary care settings, a federal research program has funded a relatively small number of studies that examine primary care, according to a new study.

The 10-year research program established under the Affordable Care Act was set up to help patients make better-informed healthcare decisions, but an analysis found only about a quarter of the 250 trials funded between 2015 and 2018 by the Patient-Centered Outcomes Research Institution (PCORI) had any relation to the primary care setting. The majority of studies were devoted to specialty care, according to the report in the Journal of General Internal Medicine. Only about 30% of the $1.17 billion spent on the research had any applicability to primary patient care.

“If the mission is to help guide patients through issues that have the greatest impact upon them, then PCORI is funneling substantial grant money where it shouldn’t be,” the study’s senior investigator, Dan Merenstein, M.D., professor of medicine and director of research programs in the department of family medicine at Georgetown University School of Medicine, said in an announcement.

“The program, which is up for renewal and may be dissolved in 2020 with grants exceeding $3.5 billion, is very disappointing to physicians who are devoted to, and strongly believe in, primary care. We should be at the forefront of such research,” Merenstein said. (Journal article, announcement)

Humana launches value-based model for oncology

Humana is working with physician groups across the U.S. to launch a value-based care oncology program designed to provide integrated treatments for its Medicare Advantage (MA) and commercial members.

Called Humana’s national Oncology Model of Care (OMOC), the program aims to improve patient experiences and health outcomes for patients with a cancer diagnosis, the insurer announced

Humana will give providers analytics and provide compensation for enhanced care navigation based on quality and cost within the following care components: inpatient admissions, emergency department visits, medical and pharmacy drugs, radiology as well as laboratory and pathology services. (FierceHealthcare)

Use of digital health activity trackers linked to better medication adherence: study

Medication adherence among those with chronic conditions is an ongoing challenge. But a recent study found that patients with diabetes and hypertension who use digital health activity trackers such as Fitbit or Apple Watch are more likely to take their medications as prescribed.

Evidation Health, a health and measurement company, analyzed Humana claims and activity data from 8,500 individuals. Those who tracked activity through wearables and connected apps by Apple, Fitbit, Garmin, and Jawbone were 1.3 times more likely to adhere to their medication regime for chronic conditions, according to the study, which was published in the Journal of Medical Internet Research. (FierceHealthcare)

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