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Mich. Derm Faces Jail Time
A Michigan dermatologist has been found guilty of defrauding Medicare and a Blue Cross Blue Shield plan. Dr. Robert W. Stokes of Grand Rapids, Mich., faces up to 10 years in prison for his conviction on 31 counts of health care fraud. The U.S. Attorney for the Western District of Michigan alleged that Dr. Stokes was upcoding surgical procedures and then billing for follow-up visits for post-operative infections that did not exist. Dr. Stokes came to the attention of federal authorities through patient complaints and audits conducted by Medicare and Blue Cross Blue Shield of Michigan. The Health and Human Services Department's Office of Inspector General and the Federal Bureau of Investigation conducted the inquiry into Dr. Stokes' billing practices and estimated that he fraudulently charged at least $500,000. Dr. Stokes has agreed to cease the practice of medicine, but has not been sentenced yet. His attorney, Mark Kriger of LaRene and Kriger in Detroit, said in an interview that his client had no fraudulent intent and will appeal the conviction.
Medicis Settles With Feds
Medicis Pharmaceutical Corp. of Scottsdale, Ariz. has agreed to pay the U.S. government $9.8 million to settle allegations that it illegally promoted Loprox (ciclopirox) as a diaper rash treatment. Loprox is not approved by the Food and Drug Administration for skin disorders in children under age 10 years. The settlement is the result of a whistle-blower complaint by four former Medicis sales representatives, who, as a result, will get a portion of the settlement. They alleged that from 2001 to 2004, Medicis representatives targeted pediatricians in an attempt to get them to prescribe Loprox for diaper rash. The case was jointly investigated by the FDA and the Kansas Attorney General's office. Medicis says "the alleged off-label promotion" was by its former pediatric sales division, which it divested in 2004. "Medicis confronted this situation head on and fully cooperated with the government, consistent with the company's strong commitment to compliance and integrity," said company general counsel Jason Hanson in a statement.
Top Ten Questions on Injectables
Safety is a top concern about the use of injectable treatments among women aged 25 years and older, according to a survey by Harris Interactive commissioned by the National Women's Health Resource Center (NWHRC) and Allergan Inc. About 1,300 women were queried by Harris in early April. After safety, respondents' next nine questions were about cost, whether results would look natural, duration of treatment and length of the procedure, insurance coverage, whether there would be pain, scarring, bruising or other side effects, and finally, if facial expressions would still be possible after treatment. The survey is part of a joint Allergan-NWHRC campaign to educate women on injectable treatments; fuller results will be released later this summer. The not-for-profit, independent NWHRC develops and distributes objective women's health information based on the latest advances in medical research and practice, according to its Web site.
IVIG Pay, Access Issues Confirmed
Two new reports from HHS confirm that Medicare payments for intravenous immune globulin (IVIG) are severely lagging behind price increases from manufacturers, making it difficult for hospitals and physicians to offer the therapy. In an April report, the HHS Inspector General found that in the third quarter of 2006, 56% of hospitals and 59% of physicians bought IVIG at prices below the Medicare reimbursement amount, which means they were able to marginally profit on the therapy. But that means that 44% of hospitals and 41% of physicians paid more for IVIG than Medicare reimbursed, said Marcia Boyle, president of the Immune Deficiency Foundation, in an interview. Further, the Inspector General found that a majority of physicians and hospitals were underpaid by Medicare relative to IVIG price for the first half-quarters of the year. Medicare acknowledged that the market was fragile, due to tight supplies and price increases and that physicians in hospitals would face the same crisis this year that they did last.
Debridement Restrictions Lifted
The American Academy of Family Physicians said it has succeeded in its drive to remove restrictive language from a Medicare carrier's draft local coverage determination on wound care. The restriction would have affected physicians in Texas, Delaware, Maryland, and Virginia. Last December, AAFP questioned TrailBlazer Health Enterprises' proposed debridement limits of three times for one wound. AAFP said that although repetitive debridement of one wound is uncommon, sometimes, serial debridement is the only option. TrailBlazer removed the restrictions from its final policy, released in April.
Juries Side With MDs
Juries in malpractice cases sympathize more with physicians and less with their patients, according to an extensive review of studies involving malpractice cases from 1989 to 2006. Philip Peters, of the University of Missouri-Columbia School of Law, found that plaintiffs rarely win weak cases, although they have more success in cases viewed as a "toss-up" and better outcomes in cases with strong evidence of medical negligence. Mr. Peters, whose study appeared in the May edition of the Michigan Law Review, said that several factors systemically favor medical defendants in the courtroom, including the defendant's superior resources, physicians' social standing, social norms against "profiting" by injury, and the jury's willingness to give physicians the benefit of the doubt when evidence conflicts.
Mich. Derm Faces Jail Time
A Michigan dermatologist has been found guilty of defrauding Medicare and a Blue Cross Blue Shield plan. Dr. Robert W. Stokes of Grand Rapids, Mich., faces up to 10 years in prison for his conviction on 31 counts of health care fraud. The U.S. Attorney for the Western District of Michigan alleged that Dr. Stokes was upcoding surgical procedures and then billing for follow-up visits for post-operative infections that did not exist. Dr. Stokes came to the attention of federal authorities through patient complaints and audits conducted by Medicare and Blue Cross Blue Shield of Michigan. The Health and Human Services Department's Office of Inspector General and the Federal Bureau of Investigation conducted the inquiry into Dr. Stokes' billing practices and estimated that he fraudulently charged at least $500,000. Dr. Stokes has agreed to cease the practice of medicine, but has not been sentenced yet. His attorney, Mark Kriger of LaRene and Kriger in Detroit, said in an interview that his client had no fraudulent intent and will appeal the conviction.
Medicis Settles With Feds
Medicis Pharmaceutical Corp. of Scottsdale, Ariz. has agreed to pay the U.S. government $9.8 million to settle allegations that it illegally promoted Loprox (ciclopirox) as a diaper rash treatment. Loprox is not approved by the Food and Drug Administration for skin disorders in children under age 10 years. The settlement is the result of a whistle-blower complaint by four former Medicis sales representatives, who, as a result, will get a portion of the settlement. They alleged that from 2001 to 2004, Medicis representatives targeted pediatricians in an attempt to get them to prescribe Loprox for diaper rash. The case was jointly investigated by the FDA and the Kansas Attorney General's office. Medicis says "the alleged off-label promotion" was by its former pediatric sales division, which it divested in 2004. "Medicis confronted this situation head on and fully cooperated with the government, consistent with the company's strong commitment to compliance and integrity," said company general counsel Jason Hanson in a statement.
Top Ten Questions on Injectables
Safety is a top concern about the use of injectable treatments among women aged 25 years and older, according to a survey by Harris Interactive commissioned by the National Women's Health Resource Center (NWHRC) and Allergan Inc. About 1,300 women were queried by Harris in early April. After safety, respondents' next nine questions were about cost, whether results would look natural, duration of treatment and length of the procedure, insurance coverage, whether there would be pain, scarring, bruising or other side effects, and finally, if facial expressions would still be possible after treatment. The survey is part of a joint Allergan-NWHRC campaign to educate women on injectable treatments; fuller results will be released later this summer. The not-for-profit, independent NWHRC develops and distributes objective women's health information based on the latest advances in medical research and practice, according to its Web site.
IVIG Pay, Access Issues Confirmed
Two new reports from HHS confirm that Medicare payments for intravenous immune globulin (IVIG) are severely lagging behind price increases from manufacturers, making it difficult for hospitals and physicians to offer the therapy. In an April report, the HHS Inspector General found that in the third quarter of 2006, 56% of hospitals and 59% of physicians bought IVIG at prices below the Medicare reimbursement amount, which means they were able to marginally profit on the therapy. But that means that 44% of hospitals and 41% of physicians paid more for IVIG than Medicare reimbursed, said Marcia Boyle, president of the Immune Deficiency Foundation, in an interview. Further, the Inspector General found that a majority of physicians and hospitals were underpaid by Medicare relative to IVIG price for the first half-quarters of the year. Medicare acknowledged that the market was fragile, due to tight supplies and price increases and that physicians in hospitals would face the same crisis this year that they did last.
Debridement Restrictions Lifted
The American Academy of Family Physicians said it has succeeded in its drive to remove restrictive language from a Medicare carrier's draft local coverage determination on wound care. The restriction would have affected physicians in Texas, Delaware, Maryland, and Virginia. Last December, AAFP questioned TrailBlazer Health Enterprises' proposed debridement limits of three times for one wound. AAFP said that although repetitive debridement of one wound is uncommon, sometimes, serial debridement is the only option. TrailBlazer removed the restrictions from its final policy, released in April.
Juries Side With MDs
Juries in malpractice cases sympathize more with physicians and less with their patients, according to an extensive review of studies involving malpractice cases from 1989 to 2006. Philip Peters, of the University of Missouri-Columbia School of Law, found that plaintiffs rarely win weak cases, although they have more success in cases viewed as a "toss-up" and better outcomes in cases with strong evidence of medical negligence. Mr. Peters, whose study appeared in the May edition of the Michigan Law Review, said that several factors systemically favor medical defendants in the courtroom, including the defendant's superior resources, physicians' social standing, social norms against "profiting" by injury, and the jury's willingness to give physicians the benefit of the doubt when evidence conflicts.
Mich. Derm Faces Jail Time
A Michigan dermatologist has been found guilty of defrauding Medicare and a Blue Cross Blue Shield plan. Dr. Robert W. Stokes of Grand Rapids, Mich., faces up to 10 years in prison for his conviction on 31 counts of health care fraud. The U.S. Attorney for the Western District of Michigan alleged that Dr. Stokes was upcoding surgical procedures and then billing for follow-up visits for post-operative infections that did not exist. Dr. Stokes came to the attention of federal authorities through patient complaints and audits conducted by Medicare and Blue Cross Blue Shield of Michigan. The Health and Human Services Department's Office of Inspector General and the Federal Bureau of Investigation conducted the inquiry into Dr. Stokes' billing practices and estimated that he fraudulently charged at least $500,000. Dr. Stokes has agreed to cease the practice of medicine, but has not been sentenced yet. His attorney, Mark Kriger of LaRene and Kriger in Detroit, said in an interview that his client had no fraudulent intent and will appeal the conviction.
Medicis Settles With Feds
Medicis Pharmaceutical Corp. of Scottsdale, Ariz. has agreed to pay the U.S. government $9.8 million to settle allegations that it illegally promoted Loprox (ciclopirox) as a diaper rash treatment. Loprox is not approved by the Food and Drug Administration for skin disorders in children under age 10 years. The settlement is the result of a whistle-blower complaint by four former Medicis sales representatives, who, as a result, will get a portion of the settlement. They alleged that from 2001 to 2004, Medicis representatives targeted pediatricians in an attempt to get them to prescribe Loprox for diaper rash. The case was jointly investigated by the FDA and the Kansas Attorney General's office. Medicis says "the alleged off-label promotion" was by its former pediatric sales division, which it divested in 2004. "Medicis confronted this situation head on and fully cooperated with the government, consistent with the company's strong commitment to compliance and integrity," said company general counsel Jason Hanson in a statement.
Top Ten Questions on Injectables
Safety is a top concern about the use of injectable treatments among women aged 25 years and older, according to a survey by Harris Interactive commissioned by the National Women's Health Resource Center (NWHRC) and Allergan Inc. About 1,300 women were queried by Harris in early April. After safety, respondents' next nine questions were about cost, whether results would look natural, duration of treatment and length of the procedure, insurance coverage, whether there would be pain, scarring, bruising or other side effects, and finally, if facial expressions would still be possible after treatment. The survey is part of a joint Allergan-NWHRC campaign to educate women on injectable treatments; fuller results will be released later this summer. The not-for-profit, independent NWHRC develops and distributes objective women's health information based on the latest advances in medical research and practice, according to its Web site.
IVIG Pay, Access Issues Confirmed
Two new reports from HHS confirm that Medicare payments for intravenous immune globulin (IVIG) are severely lagging behind price increases from manufacturers, making it difficult for hospitals and physicians to offer the therapy. In an April report, the HHS Inspector General found that in the third quarter of 2006, 56% of hospitals and 59% of physicians bought IVIG at prices below the Medicare reimbursement amount, which means they were able to marginally profit on the therapy. But that means that 44% of hospitals and 41% of physicians paid more for IVIG than Medicare reimbursed, said Marcia Boyle, president of the Immune Deficiency Foundation, in an interview. Further, the Inspector General found that a majority of physicians and hospitals were underpaid by Medicare relative to IVIG price for the first half-quarters of the year. Medicare acknowledged that the market was fragile, due to tight supplies and price increases and that physicians in hospitals would face the same crisis this year that they did last.
Debridement Restrictions Lifted
The American Academy of Family Physicians said it has succeeded in its drive to remove restrictive language from a Medicare carrier's draft local coverage determination on wound care. The restriction would have affected physicians in Texas, Delaware, Maryland, and Virginia. Last December, AAFP questioned TrailBlazer Health Enterprises' proposed debridement limits of three times for one wound. AAFP said that although repetitive debridement of one wound is uncommon, sometimes, serial debridement is the only option. TrailBlazer removed the restrictions from its final policy, released in April.
Juries Side With MDs
Juries in malpractice cases sympathize more with physicians and less with their patients, according to an extensive review of studies involving malpractice cases from 1989 to 2006. Philip Peters, of the University of Missouri-Columbia School of Law, found that plaintiffs rarely win weak cases, although they have more success in cases viewed as a "toss-up" and better outcomes in cases with strong evidence of medical negligence. Mr. Peters, whose study appeared in the May edition of the Michigan Law Review, said that several factors systemically favor medical defendants in the courtroom, including the defendant's superior resources, physicians' social standing, social norms against "profiting" by injury, and the jury's willingness to give physicians the benefit of the doubt when evidence conflicts.