This is where something hits the wall. What’s next go repossess the units? This comes back to the coding once more and again 3rd parties are involved with some of these evaluations.
Give me a break as this is where it goes too far and granted there probably are analytics in place today that set the scenarios for Medicare coverage but to go back like this is a complete waste of taxpayer money. Hospitals have enough to do right now and some are not doing well financially so again what a waste of time and bean counter effort here. Again I agree on all present and future defibrillators going under the proper scrutiny but how far is all the billing in healthcare going to go with digging back. It’s a waste as the algorithms just come in and shift some more money around. Everything in the past does not have to be picture perfect and the general public as has been stated in many surveys would love to see more criminals in the financial district brought to task. We already have this going on in the re-admissions area so now we add another task on and for how much recovery. Any more unless at least $10 million is going to be recovered forget it as this is just a working hardship on everyone and again computer science folks are much quicker to look at an ROI than attorneys for cases as such. BD
Medicare Re-Admissions Penalties–Algorithms Keep Money Shifting and Make It Difficult for Realistic Budgets to be Met Along With Good Patient Care–Algos Keep the Money Moving In One Direction or Another
In what experts say is a novel legal tactic to resolve hundreds of ongoing investigations simultaneously, the Justice Department is e-mailing hospitals across the country today with instructions to examine questionable implantable defibrillator surgeries on Medicare patients and estimate potential penalties under the False Claims Act.
Hospitals face a wide range of potential damages. At up to $40,000 apiece, the implanted devices that regulate irregular heart rhythms are among the most expensive devices healthcare providers can bill Medicare for, and lawyers say hospitals with high volumes of such surgeries have been asked to provide information of hundreds of cases each.
For more than two years, prosecutors with the Justice Department have been using data-mining technology, civil investigative demands and collaborative meetings with experts to investigate the question of whether some Medicare patients received implanted defibrillators outside of strict CMS rules on when such devices can be used.
The “resolution model” document, which Modern Healthcare obtained copies of Thursday (PDF), says each questionable ICD case will be evaluated individually. Hospitals are being told to self-audit the cases and estimate damages, with the severity of penalties based on whether the hospital had medical reasons to violate CMS rules; if patient harm resulted; if the hospital had prior knowledge or a statistical pattern of non-guideline implants; and if a hospital compliance program was in place.