When it comes to record-breaking Medicare fraud busts, the hits keep coming.  The feds announced today another nationwide takedown of physicians and other healthcare providers for Medicare fraud totaling in excess of $450 million.  All told, 107 people have been charged in this week’s bust for, among other things, submitting false claims to the Medicare program.  Read more about it here.

While these headline-grabbing takedowns usually involve some pretty egregious billing practices, law-abiding physicians and other providers should still take note as it is inevitable that the government’s increased efforts to identify fraud will also identify billing errors and inadvertent overpayments.  If you are not regularly having your charts and billings audited by an independent auditor under attorney-client privilege, it is highly advisable to begin doing that regularly as the basis of a practice compliance program.

“Having an enlarged prostate is very common in many men over the age of 50, and these new findings provide hope for those who might not be candidates for transurethral resection of the prostate, or TURP–and may allow them to avoid serious complications that sometime result from surgery, such as impotence, retrograde ejaculation and urinary incontinence. This could mean that more men have a chance at getting their lives back,” said Francisco Cesar Carnevale, M.D. Ph.D., professor and chief of the interventional radiology section at the Hospital das Clinicas Hospital of the Faculty of Medicine at the University of Sao Paulo in Brazil.

With age, a man’s prostate can grow larger due to a noncancerous process called benign prostatic hyperplasia, or BPH. This enlargement can compress the urethra and cause urination and bladder problems. For these men, symptoms can cause a marked decrease in quality of life, said Carnevale.

According to Carnevale, “Interventional radiologists have always pioneered the use of minimally invasive treatments for many disease states. Interventional radiologists have used embolization, where a catheter is used to deliver tiny beads to block blood flow to a target area, for many years to treat uterine fibroids, on an outpatient basis, with very few complications. Applying this same principal to the prostate by embolizing or blocking the prostatic arteries, thereby reducing its size and releasing the pressure on the urethra so that a man is then able to void normally, seemed like a natural progression.”

“This study looked at results from men who suffered with acute urinary retention due to an enlarged prostate and who were treated,” noted Carnevale, who indicated that prior to embolization, all had medical treatment and urethral catheters and were waiting for surgery. “After the treatment, we assessed quality of life and evaluated how well the urinary system was working. Clinical success was seen in 91 percent of those treated and technical success was evident in 75 percent of those treated,” he added.

Using a tiny one-millimeter diameter microcatheter threaded into the prostate arteries, 12 prostatic artery embolization procedures using resin microspheres as embolizing agents were performed on 11 individuals (ages 59-78 years; average age, 68.5 years) under local anesthesia. Magnetic resonance imaging and ultrasound were also used to study the exact anatomy of the prostate.

“Although these preliminary results are very promising for American men, it must be noted that prostate artery embolization is an extremely advanced embolization procedure requiring rigorous training and a detailed knowledge of the prostate anatomy and surrounding vessels,” said James B. Spies, M.D., MPH, FSIR, professor and chair of the radiology department at Georgetown University Medical Center in Washington, D.C. “Because interventional radiologists are the leaders in bringing forth new treatments responsibly, I expect there will be considerable additional study, including multicenter clinical trials, that explore the safety, efficacy and durability of this procedure before it will become broadly available in clinical practice. At that stage, the specialty will take the lead on ensuring that practice guidelines are established to ensure appropriate patient care,” he added.

New research from NASA suggests that prolonged periods of time in space may cause serious damage to your eyes. Brain scan tests were performed on 27 astronauts who had spent an average of 108 days floating in space.

About a third of the astronauts had an increase in the cerebrospinal fluid space that surrounds their optic nerve. Another 22% seemed to have endured a flattening of the back of their eyeball.

There were also incidences of bulging optic nerves and pituitary gland abnormalities. Such symptoms are often associated with idiopathic intracranial hypertension essentially increased pressure around the brain.

There was no control data against which to compare these results since all of these astronauts had been in space before.

According to the chief of flight medicine clinic at NASA’s Johnson Space Center in Houston, William Tarver, “NASA has placed this problem high on its list of human risks, has initiated a comprehensive program to study its mechanisms and implications and will continue to closely monitor the situation.”

MT. LAUREL, N.J., Mar 20, 2012 (BUSINESS WIRE) — USARAD.com announces a Joint Venture between its international subsidiary WorldRad.com division and Global Hawk Telemedicine based in the United Arab Emirates (UAE) to fill the expanding need for quality MRI and CT subspecialty reads in the Middle East. The Joint-Commission accredited USARAD.com will provide U.S. board-certified and highly qualified American Board Certified radiologists in a full range of radiology sub-specialties to contribute to Global Hawk Telemedicine services. Initially, the partnership will operate in Dubai and then expand into other areas in United Arab Emirates and other parts of Middle East.

Global Hawk Telemedicine (GHT) is the leading telemedicine service provider in the Middle East and offers high quality sub-specialty radiology interpretations with a rapidly increasing panel of sub-specialty radiologists. It is a division of Global Hawk Imaging & Diagnostics (GHID), a prestigious chain of diagnostic imaging centers throughout the Middle East and other countries. Its patients include many well-known members of the royal family of the UAE and representatives of foreign embassies and consulates.

Global Hawk Telemedicine is the only UAE teleradiology service provider recognized by Dubai Health Authority and offers a full range of advanced services, including PET/CT, neuroradiology, musculoskeletal, cardiac, breast, oncological, abdominal, thoracic and coronary CTA imaging.

WorldRad.com will help the prestigious UAE-based teleradiology group maintain its commitment to exam turnaround in 30 minutes for emergency cases and 4 hours for standard reads, while upholding a commitment to the highest standards of care.

A partnership based on a shared commitment to advanced technology, both WorldRad.com and Global Hawk Telemedicine are supported by sophisticated proprietary digital image management and communications infrastructures that speed images in high diagnostic quality across the globe if needed to support ultra-fast, high quality exam reading. Both practices also offer a full range of imaging technology solutions to clients to facilitate state-of-the-art reciprocal communications of images and reports.

According to Michael Yuz, MD, MBA, CEO of USARAD.com & WorldRad.com, although equipped with advanced imaging technology, many areas of the Middle East are suffering from a shortage of radiologists qualified to read today’s advanced imaging exams. “Practices like Global Hawk Telemedicine, offering the highest quality imaging expertise, are providing a vitally important service,” he says. “In partnership with WorldRad.com, Global Hawk Telemedicine can offer reading by highly trained radiologists in locations around the world for 24/7 service.”

President and founder of Global Hawk Telemedicine and Global Hawk Imaging & Diagnostics Dr. Nawab Shafi Ul Mulk, MD comments, “Our mission is to work with imaging centers and hospitals in United Arab Emirates and expand into other parts of Middle East shortly, to ensure that patients in underserved regions receive the advanced medical care they deserve. We have created a strong infrastructure of both human talent and technology to support these goals. Today, we are pleased and proud to have WorldRad.com join with us to further these goals and look forward to a long relationship with the company.”

Dr. Mulk notes that in today’s global healthcare marketplace the sharing of expertise across political and geographic boundaries is essential and easily made possible with the appropriate organization and technology. Mulk’s group is investing 120 million dirhams in the next 3 years across GCC Countries for a chain of 10 branded Global Hawk Imaging centers, with the pilot GHID project of 12 million already operational after 5 months in Dubai.

Dr. Mulk added, “An intense desire to contribute to the healthcare system and paucity of quality imaging and diagnostics centers with an acute shortage of sub-specialty physicians in this region culminated in pioneering and successful implementation of teleradiology services in UAE. We were further buoyed by positive feedback and strong support by visionary leaders and senior DHA officials. GHT is an integral part of reputed Multinational Mulk group and will further continue to invest in the healthcare journey by bridging distances across the continents with multidisciplinary telemedicine consultations, aided by innovative Mulk healthcare products.”

“Together, Global Hawk Telemedicine and WorldRad.com make that service a reality,” adds Dr. Yuz. He also points out that for many hospitals and medical practices, teleradiology can provide a cost-effective, efficient solution keeping them up to date with the latest imaging techniques and technologies for the benefit of their patients.

About USARAD.com and WorldRad.com

WorldRad.com is an international subsidiary corporation of USARAD.com providing service in multiple parts of the world including Europe, Asia, South America and the Middle East. USARAD.com is a fully physician-owned and operated company that interprets general and a full range of subspecialty exams in all imaging modalities. Utilizing unique Radiology-On-Demand™ cloud-based technology, USARAD.com is committed to providing timely and responsive image review using highly qualified specialists. All subspecialty interpretations are performed by board certified fellowship-trained radiologists and cardiologists. USARAD.com offers state-of-the-art proprietary RIS and PACS technology for advanced report communications with client sites via web-based interface and fax.

USARAD.com, headquartered in Mt. Laurel, New Jersey, is one of the fastest growing teleradiology groups in the country and world. The company provides 24/7/365 service in all 50 states for imaging centers, hospitals and mobile imaging providers.

About Global Hawk Telemedicine-Middle East/UAE

Pioneering Teleradiology medical company of UAE is part of world brand Multinational Mulk Holdings, a conglomerate of 21 diversified, reputed companies with an estimated market value more than 2 billion dollars. It is also the world’s largest manufacturer of Alubond — USA, a branded high quality building product used across more than 36 countries. GHT is the only Dubai Health Care Authority recognized Telemedicine/Teleradiology service provider in the region. They offer high quality subspecialty radiology interpretations with a rapidly increasing panel of more than 95 US/UK/UAE/GCC based trained Sub-Specialist Radiologists to provide Teleradiology Outsourcing Solutions.

Paulette Eversole arrived at the emergency department of Winchester Medical Center (WMC) January 19th 2010 at 8:20 p.m. with “excruciating, unremitting epigastric abdominal pain.”

Doctors ordered scans and sent them to Nighthawk Radiology.

The suit says:
“WMC did not have trained and qualified radiologic health care providers on-site to read or interpret Mrs. Eversole’s CT scans.”

The lawsuit says a Nighthawk radiologist interpreted the 230 images and reported all visceral organs appeared “normal with no acute findings” and that he failed to report Mrs. Eversole’s superior mesenteric artery had closed and her celiac artery had nearly closed.

The lawsuit also says a radiologist of Winchester Radiologist, PC, later evaluated the CT scans of her pelvis and abdomen and evaluated them as “normal.” The lawsuit says in fact the scans showed “evidence of significant vascular pathology of the mesenteric arteries.”

An endoscopy showed blanching of the mucosa of the stomach, the lawsuit says, a doctor ordered a magnetic resonance angiogram (MRA). However, the lawsuit says, the hospital had to delay the MRA because it had “oversedated” Mrs. Eversole despite a warning from her family that certain medications made her unresponsive.

After the MRA was finally performed, the lawsuit says, it showed the superior and inferior mesenteric arteries had closed and the celiac artery had almost closed.

“Upon cutting her open,” the lawsuit says, “there was a foul stench. All of her visceral organs were black and necrotic.”

Mrs. Eversole died on January 22, 2010. The lawsuit contends that negligence caused “critical” delays in her diagnosis and treatment.

With this in mind, the OIG’s recently released Work Plan for Fiscal Year 2012 provides the regulated community with a roadmap of the areas that will receive additional scrutiny from OIG. These include:

● Payment systems controls that identify high cumulative Part B payments made to physicians;
● Claim submission practices of, and private contracts entered into by, physicians who have opted out of Medicare;
● Physicians’ coding on Part B claims, for services performed in ambulatory surgical centers and hospital outpatient departments;
● Providers’ compliance with assignment rules relating to billings that exceed Medicare-allowable amounts; and
● Part B payments for chiropractic services.

This list only skims the surface of those “new” areas of OIG focus, and does not take into account its existing areas of investigation.

Moreover, these priorities also extend beyond fines and penalties and also cover exclusion of individuals from participation in federal health care programs. For instance, in fiscal year 2010, over 3,300 individuals and entities were excluded from such participation. A recent Government Accountability Office (GAO) report criticized HHS and suggested that it should be paying greater attention to its suspension and debarment programs, by perfecting its use of staff and developing guidance to implement these programs. Assuming HHS follows even some of these recommendations, we can also expect to see more suspensions and debarments in the coming year.

Posted by Todd Rodriguez

Advanced diagnostic imaging procedures include diagnostic magnetic resonance imaging (MRI), computed tomography (CT), and nuclear medicine imaging such as positron emission tomography (PET).

CMS has named the American College of Radiology (ACR), the Intersocietal Accreditation Commission (IAC), and The Joint Commission (TJC) as the accrediting organizations.

WRITTEN BY USARAD.COM GENERAL COUNSEL TODD RODRIGUEZ

The spike in fraud investigations and prosecutions should come as no surprise given that the Obama administration has placed heavy emphasis on fraud, waste and abuse recoupment as a means of funding new healthcare reform legislation. On top of this, healthcare enforcement authorities are using new and more advanced means (e.g., enhanced technology and cooperative task force operations) to identify fraud and abuse. And, frankly, there is still plenty of fraud, waste and abuse in the system. It is often said that desperate times lead to desperate measures and as the economics of healthcare delivery get tighter, I expect we will see healthcare providers more willing to enter into riskier arrangements than they might in better economic times. All of these factors of course spell a potential “perfect storm” from a healthcare compliance perspective, so physicians and providers should take careful stock of there compliance efforts, including regular documentation and billing audits and a regular review of contractual arrangements to ensure compliance with applicable federal and state fraud and abuse legislation.

Written by USARAD.com general counsel TODD RODRIGUEZ