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Providers Can’t Shop Around For Carriers

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Date: Sat, 1 Dec 2001 06:41:59 -0600
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<http://www.medicalnewswire.com/archive/> 	Friday, November 30,
2001	
Headlines	Subscribe <http://www.medicalnewswire.com/subscribe/> 	
Providers Can’t Shop Around For Carriers
Why Bother With Medicare Repayments
Kickbacks Lead To Jail For Hospital Doc And VP
Relaxation Therapists Want Medicare Coverage
	

Providers Can’t Shop Around For Carriers	
DENVER, CO (Medical Newswire) Health care companies that operate in
multiple states can't pick and choose which Medicare contractor to
submit their claims to, as a Teterborough, NJ-based clinical lab
recently learned the hard way.

According to Colorado U.S. Attorney John Suthers, Quest Diagnostic Inc.
Nov. 21 agreed to pay more than $350,000 to settle a 1998 qui tam case
filed by the former controller of its Billings, MT lab. Whistleblower
Donna Scott accused Quest of attempting to boost its Medicare
reimbursement by improperly exploiting variances in different carriers'
fee schedules. In particular, Quest allegedly submitted claims to the
Colorado carrier that ought to have been sent to carriers in New Mexico
and Utah. 

In 1998 and 1999, after an internal investigation, Quest had come
forward with certain claims that ought to have been submitted to the
Utah carrier, but actually were submitted in Colorado. At that time, the
company returned more than $120,000 to Medicare, based on the difference
between the Utah and Colorado fee schedules for certain diagnostic
testing services. The Nov. 21 settlement brings the total value of the
contractor snafu to $475,000.

Scott will collect a $71,100 bounty for her role as whistleblower.

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Why Bother With Medicare Repayments	
RESEARCH TRIANGLE PARK, NC (Medical Newswire) The debate on overpayments
is roiling on Capitol Hill, as Congress debates new policies that could
keep CMS from demanding repayment while a provider appeal is in the
works. Some proposals would allow repayment over extended periods of
time in cases of severe financial hardship. And other changes may be on
the way…

That's why you need our experts to guide you through the minefield of
handling overpayments. Assuming that inconsistencies will always “come
clean in the wash” can be a grave mistake, says Ankur Goel, a partner
with Washington-based McDermott, Will & Emery. “At the same time, the
government is considering provisions that will spell relief for some
providers,” adds attorney Heidi Kocher with Brown & Fortunato in
Amarillo, TX.

Goel and Kocher will help you find the strongest financial ground -
while remaining compliant - at Eli Research’s audio seminar, “Medicare
Repayments: Whether, When and How to Make Them.” The conference will
take place on Tuesday, Dec. 11, 2001 from 1 to 2:30 p.m. “This realistic
approach will get all your decision-makers on the same, correct page,”
comments Goel.

Program highlights include seven tough questions you must answer before
making the decision to repay; how to distinguish between situations
calling for repayments and those requiring disclosures; an in-depth
exploration of the mechanics of repayments; and practical tips for
integrating repayment and disclosure decisions into your compliance
plan. “We’ll show you how to make good decisions during the repayment
process,” promises Kocher.

Nursing home administrators will earn CEU’s at this seminar.

For more information about registration and pricing, call 1-800-874-9180
or visit: 

*	http://www.eliresearch.com/repayments.html

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Kickbacks Lead To Jail For Hospital Doc And VP	
CHICAGO, IL (Medical Newswire) The long-running kickback probe of
Chicago's troubled Edgewater Medical Center tallied prison terms for a
physician and the facility's former senior vice president Nov. 28.

A federal district court judge sentenced Roger Ehmen to 6 1/2 years in
prison and Dr. Ravi Barnabas to a term of 52 months for their roles in a
health care fraud scheme, the Chicago Tribune reports. The ploy involved
the payment of kickbacks to physicians in exchange for referrals of
patients to Edgewater for hospital care - care that in many cases wasn't
necessary, prosecutors say. 

Ehmen also was ordered to pay $5 million in restitution, according to
the Tribune; Barnabas must pay $1.1 million.

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Relaxation Therapists Want Medicare Coverage	
SOUTH BEND, IN (Medical Newswire) Learning how to lead a more relaxed
life may be a key part of recovering from cardiac illnesses, but should
Medicare pay for relaxation lessons?

That question may be answered by a new study on the effects of
relaxation therapy on cardiac patients, according to the South Bend
Tribune of South Bend, IN. Three medical centers in California, Indiana
and Pennsylvania are participating in the study, in which patients who
have been treated for heart attacks and coronary artery blockages will
receive lessons in exercise, nutrition and relaxation as part of their
rehab.

The patients will work out in an exercise room, then lie on mats and
listen to classical music or the sounds of ocean waves. Following this
relaxation exercise, they’ll take nutrition classes.

Proponents of this mind/body approach hope to yield quantitative
evidence with which to sway the Centers for Medicare & Medicaid Services
into covering relaxation therapy services.

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Received on Friday, 30 November 2001 18:38:42 UTC

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