Medicare Proposes Adding to Its List of Hospital-Acquired Conditions For Which It Will Not Pay the Extra Costs

The Centers for Medicare and Medicaid Services (CMS) is proposing to add an additional nine categories to its initial list of 8 preventable conditions that could reasonably have been avoided. that Medicare will no longer pay the extra costs of treating when acquired in the hospital.

In a statement dated April 14, 2008, CMS proposed to add the following to its list of preventable conditions that it will not pay for: Surgical site infections following certain elective procedures: Legionnaire’s disease; Extreme blood sugar derangement; Iatrogenic pneumothorax or collapsed lungs; Delirium; Ventilator-associated pneumonia; Deep vein thrombosis or pulmonary embolism; Staphylococcus aureus … 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

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