Doctors Successfully Repel Aetnas Unwarranted Intrusion Into How They Perform Colonoscopies

After coming under attack from doctors, Aetna has withdrawn its intention, announced late last year, that in New Jersey, effective April 1, 2008, it would drop its coverage of propofol, the anesthesia typically used during colonoscopies, calling the same medically unnecessary. In reality, it is not the propofol that Aetna minds paying for; what Aetna wants to cut-out is the $300 to $1,000 cost that Aetna pays for an anesthesiologist to be present at a colonoscopy.

Propofol, also known by the trade name Diprivan, is more powerful than other sedatives traditionally used to help patients endure the discomfort of a … Read the rest

Medical Device Manufacturer’s Settlement of Kickback Charges Shows That Even Criminal Fines Can Be “Privatized”

The U.S. Attorney for New Jersey directed that a no-bid 18-month contract worth $28 million to $52 million contract be awarded to The Ashcroft Group, the consulting firm of former Attorney General John Ashcroft, to monitor a large settlement of criminal accusations against medical device manufacturer Zimmer Holdings and four smaller companies accused of paying kickbacks to doctors who recommended and used the company’s knee and hip implants.

U.S. Attorney Christopher J. Christie directed that the contract be awarded to his former boss with no public notice. Mr. Christie said the fees were imposed in lieu of fines.

If … Read the rest

Report on Medicare/Medicaid Overbilling and Fraud in 2007 Focuses on Nursing Homes/Rehab Centers, Pharmaceuticals and Boutique Hospitals

Americas Watchdog and its Corporate Whistleblower Center have just released the results of its third annual study focused on Medicare & Medicaid fraud. The report continues to show widespread Medicare/Medicaid billing abuse and fraud involving all aspects of health care.

The Corporate Whistle Blower Center has just reported its 2007 year end findings on the state of Medicare/Medicaid over billing/fraud in the United States. The report included three areas where Medicare/Medicaid are being over-billed or defrauded; nursing homes/rehab centers, pharmaceuticals, and boutique hospitals, not for profits hospitals, or hospitals owned by doctors/investor groups.

1. Most Nursing Homes/Rehab Centers continue … Read the rest

Health Insurers’ Physician Ranking Programs Spark Concerns About Consumer Deception: Investigation by New York Attorney General Leads to Agreement

New York Attorney General Andrew M. Cuomo has been conducting an industry-wide investigation of doctor ranking programs, concerned that the insurers use their ranking system to steer their insureds to doctors who cost the insurers less but are not as well qualified to treat the insured as physicians who are more expensive for the insurer to pay. This investigation has led to an agreement, announced earlier this week, with healthcare industry leader, CIGNA Healthcare, regarding its doctor ranking programs.

Investigations performed under the leadership of the Attorney General show that consumers cannot rely on these programs blindly. Previously, in letters … Read the rest