December 2000 Bulletin

In Brief

Election results

Paul Perry, MD, a Newburgh, Ind. orthopaedic surgeon, was unsuccessful in his bid for election to the U.S. House of Representatives from the 8th district in Indiana. In a hotly contested race, Dr. Perry received 100,461 votes to Rep. John Hostetler’s 116,860 votes (unofficial as of this writing). Rep. Hostetler was running for a fourth term in Congress.

The battle in Indiana’s "Bloody Eight" district was, according to the Wall Street Journal, a microcosm of this year’s congressional race tactics. "Dr. Perry is running as a people’s physician whose first passion is standing up for his patients against insurance companies and the pharmaceuticals industry–echoing the recent populist strategy of his party’s presidential candidate, Vice President Al Gore," the newspaper said. "The soft-spoken Evansville surgeon reflects a new Democratic pragmatism by tracking close to the GOP hot-button social issues of abortion and gun control, both of which he opposes."

Jeffery Thomas, MD, orthopaedic surgeon, was unsuccessful in his bid for election to the U.S. House in the 1st district in Wisconsin. He received 89,253 votes to Paul Ryan’s 176,673 votes.

In other elections for seats in Congress, the following incumbent physician-lawmakers were reelected: Rep. Ernie Fletcher, (R-Ky.); Rep. Jim McDermott (D-Wash.); Rep. Victor Snyder (D-Ark.); Rep. John Cooksey, (R-La.); Rep. Greg Ganske (R-Iowa); Rep. Ron Paul (R-Texas); Rep. Dave Weldon (R-Fla.); and Sen. Bill Frist (R-Tenn.).

Antitrust bill

Rep. John Conyers (D-Mich.), cosponsor of the Quality Health Care Coalition bill that would allow physicians to negotiate collectively with insurers, won reelection and vowed to reintroduce the legislation. The bill was approved by the U.S. House of Representatives by a 276-136 vote, but never got a sponsor in the U.S. Senate. Rep. Thomas Campbell, (R-Calif.), also cosponsor of the bill, was defeated in his bid to wrest a U.S. Senate seat away from Sen. Dianne Feinstein (D-Calif.).

Needle safety

President Clinton signed legislation aimed at reducing needlestick injuries to healthcare workers. The Needlestick Safety and Prevention Act will require hospitals and other healthcare facilities to use safer "sharps" and needleless systems.

The new law amends the Occupational Safety and Health Administration’s blood-borne pathogen standard. An OSHA compliance directive regarding the use of safer sharps has been in place since November 1999; the new law will codify the directive.

The legislation will also require healthcare facilities to maintain a log of needlestick injuries and involve healthcare workers in the selection of safer sharps technologies. The law is expected to take effect in nine months.

Each year 600,000 to 800,000 health care workers are stuck by needles or other sharp objects. The national Surveillance System for Hospital and Health Care Workers says 44 percent of the needlesticks involve nurses; 30 percent, physicians; and 13 percent, technicians.

OIG’s 2001 plan

The Office of the Inspector General (OIG) of the Department of Health and Human Services will evaluate the impact of recent standardization and expansion of Medicare coverage of bone density screening in fiscal year 2001.

The OIG’s Fiscal Year 2001 Work Plan, covering activities involving hospitals, home health, physicians, medical equipment and other areas, says that "as the number of claims for bone density screening increases, there are questions about the appropriateness and quality of some services."

The OIG will continue to "verify compliance with Medicare rules governing payment for physicians services provided in the teaching hospital setting and to ensure that claims accurately reflect the level of service provided to patient."

The OIG also will evaluate the practice of allowing physicians to reassign their billing numbers to clinics. The OIG notes this practice provides considerable convenience to both physicians and clinic business offices. "We will examine past reassignment abuses to determine specific vulnerabilities," the OIG said.

The agency will evaluate conditions under which physicians bill "incident-to" services and supplies. "Incident-to services, which are paid at 100 percent of the Medicare physician fee schedule, must be provided by an employee of the physician and under the physician’s direct supervision," the OIG said. "Because little information is available on these types of services being bill, questions persist about the quality and appropriateness of these billings."

The OIG will launch a national review to determine the extent to which podiatrists improperly bill Medicare. "Our work at a podiatrist in one state disclosed a very high error rate (99%) and anecdotal evidence suggests that other podiatrists’ claims may be a significant problem," the OIG said. From 1992 through 1995, Medicare expenditures for nail debridement increased 46 percent, while Medicare expenditures for all other Part B services increased only 18 percent.

Fraud cases

Health care fraud cases topped the list of the Justice department’s civil fraud recoveries in the past fiscal year. Recoveries of health care cases totaled more than $840 million of the record $1.5 billion collected by the Justice department. The total recovery was almost 50 percent more than the largest previous annual recovery in 1997.

Health care cases included the largest civil fraud recovery ever–a $385 million settlement with Fresenius Medical Care to resolve allegations of wrongdoing by its kidney dialysis subsidiary. The department also recovered $170 million from Beverly Enterprises, Inc., the largest nursing home operator in the United States, for alleged false billings to Medicare involving over 400 nursing homes around the country.

"Health care fraud imposes enormous costs on American taxpayers and decreases the quality of care provided to patients," said Assistant Attorney General David W. Ogden of the department’s civil division. "Although the vast majority of health care providers are honest and provide the highest standard of care, stopping those who prey on the health care system remain one of the department’s top law enforcement priorities."

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