A new survey conducted by L.E.K. Consulting indicates a predicted rise in spending and aggressive supplier negotiations by hospitals during 2012. The study, which surveyed 200+ hospital executives, found that 61% expect budgets to grow through the year, in such areas as healthcare I.T. (57%), facilities and major medical devices (35%), and many expect growth in infection-fighting disposables. In fact, budgets are expected to rise through the coming five year period.
But the study also revealed that hospitals can be expected to drive ever harder bargains for their purchasing. Eighty percent stated that they will continue or step up pressure on suppliers to cut costs, while the number that anticipate greater use of purchasing organizations grew from 52% to 62% over last year.
The investigators cited the Affordable Care Act as a driver for the increase in hospital spending. CarePrecise healthcare provider data contains 31,270 hospital records as of February 29, 2012, representing 5,755 hospitals with 942,000 beds and total 2011 expenditures of $751 billion.
March 7, 2012
January 29, 2012
Practice Group Data Now Part of CP ListMaker
Jan. 29, 2012 -- CarePrecise announces a major upgrade of its CP ListMaker software that puts all 3.5 million U.S. healthcare provider records – including almost one million physicians – in reach for marketers. Now includes practice group data to help qualify sales leads.
Today we announced a new version of our popular CP ListMaker software, our desktop system that puts all of the 3.5 million healthcare provider records – including approximately one million physicians and tens of thousands of hospitals and ambulatory care facilities – at the fingertips of researchers and marketers. CP ListMaker allows users to pull tightly targeted lists of physicians and other providers based on criteria such as specialty, subspecialty, facility types for organizations, provider gender, wealth/poverty of service area, Medicare enrollment, and many more. The new version, CP ListMaker 3.5, unveils new practice group data, and does it in an interesting way.
Until now, it has been difficult to find data indicating provider’s practice groups. With new data now obtained from Centers for Medicare and Medicaid Services (CMS), combined with CarePrecise’s advanced record linkage system, CP ListMaker identifies practice groups, and can list all of the providers working at each practice location.
The “Co-location codes” attached to each record make it possible to further qualify potential prospects for companies marketing to the medical community. Not only physician practices, but dental groups, behavioral services groups, and all other HIPAA-covered healthcare providers are co-location coded. The new CP ListMaker offers tools for using the new data. For example, to export a list of obstetric/gynecology group practices of between 3 and 20 members.
CarePrecise’s record correlation processes also make it possible to link providers’ PECOS and LEIE records with their NPI (National Provider Identifier) records ( http://www.careprecise.com/pecos-npi ), providing a rich master record ( http://www.careprecise.com/provider-data-linkage.htm ) that can be used to enrich or update customers’ existing databases. The PECOS data (indicating which providers are enrolled to be able to bill Medicare) has recently been redacted by CMS, now providing only a partial NPI number; however, our system restores the full NPI number. The federal List of Excluded Individuals/Entities (LEIE) database, which lists providers who have been barred from billing federal programs due to fraud convictions or other infractions, also has no unique identifier as distributed; however, CarePrecise links the LEIE data to the NPI data with each monthly update.
With or without a unique identifier, such as an NPI, EIN, UPIN or OSCAR -- or even a telephone number -- the CarePrecise master data management system, known as QoRelate® (http://www.careprecise.com/provider-data-linkage.htm ), can pull provider data together into a master record database from diverse sources. The company offers boutique record linkage services that can be used to merge data acquired during mergers and acquisitions, through cooperatives such as Health Information Exchanges, or from multiple in-house systems.
CP ListMaker is available as part of the CarePrecise Gold bundle, which includes CP ListMaker and the full U.S. healthcare provider database, or separately for customers who already subscribe to the CarePrecise data. The tool runs in Microsoft Access 2003, 2007 and 2010, and is provided open source, making all of the Access tools available to users.
RESOURCES:
CP ListMaker healthcare provider research and market targeting tools:
http://www.careprecise.com/cplistmaker
http://www.careprecise.com/cplistmaker
QoRelateMaster Data Management & Record-Linkage:
http://www.careprecise.com/provider-data-linkage.htm
http://www.careprecise.com/provider-data-linkage.htm
CarePrecise Gold (complete U.S. healthcare provider database with marketing and research tools):
http://www.careprecise.com/gold
http://www.careprecise.com/gold
Contact CarePrecise:
http://www.careprecise.com/contact
http://www.careprecise.com/contact
January 7, 2012
Sorting Out Practice Group Data
Starting with the November 2011 distribution, CMS began including 15 new fields in the NPPES database related to practice groups. These are actually taxonomy codes; the taxonomy code set includes two group codes: 193200000X Multi-Specialty Group and 193400000X Single Specialty Group. The definition of the single specialty code is "A business group of one or more individual practitioners, all of who [sic] practice with the same area of specialization." That should clear it all up, right? Oh, no.
So these are not necessarily physician groups. That's fine, but additional questions remain, like Why aren't these taxonomy codes reported in the taxonomy codes section of the NPPES? The documentation from CMS is mum. And why is it that individual (Type 1) practitioners can call themselves a "group" when the NPI regulation says that a Type 1 provider is a single human being ? There are more than 1,000 of these in the data. So, a group can be physicians or not, or a mix, and a group can be one guy. And these two taxonomy codes aren't in the providers' taxonomy code data. Oh, and providers can report these same two codes up to 15 times (presumably having some relation to the up to 15 taxonomy codes in that other section of the data?) And, given 15 fields to play with, they can report being both a single specialty group and a multi-specialty group.
Hrrmph.
And there just happens to be many more group practices out there than are reported via these codes.
Using the new group codes data to actually identify groups, then, is somewhat less than doable. So we've taken a different tack.
Many of our clients need to know the group status of an individual practitioner. Let's take some really common examples. Let's say you are putting together a clinical trial for a new drug, or a marketing campaign for a new device. By phone, fax, and/or mail, you plan to contact a few thousand physicians in this state, a few thousand in that state, etc. You don't want to deluge a practice with 50 letters or phone calls all at once (and some practice locations are that big and bigger), so you need to know the practice group for the physicians on your list, so you can stagger your communications. Or, let's say, you just want to reach the CEO or medical director for a given group. Well, as it happens, the CEOs isn't always the record that indicates a group practice; it's sometimes the office manager, credentialing coordinator, or just a young doc who can pilot the laptop. How do you sort all this out? Well, frankly, you couldn't, until now.
Beginning this month the CarePrecise Access dataset contains a new feature called a "CoLoCode" (co-location code). The CoLoCode is derived from deeply conformed practice location data, and each provider record gets one. Look up a group (using the CMS Group codes or by looking for a number of physicians co-located at the same practice address), then plunk that CoLoCode into a query to show you all the providers practicing at that location. Voila!
To make it even easier, we are releasing a new version of our CP ListMaker software, with new group features that take full advantage of the CoLoCodes and new CMS group data.
So these are not necessarily physician groups. That's fine, but additional questions remain, like Why aren't these taxonomy codes reported in the taxonomy codes section of the NPPES? The documentation from CMS is mum. And why is it that individual (Type 1) practitioners can call themselves a "group" when the NPI regulation says that a Type 1 provider is a single human being ? There are more than 1,000 of these in the data. So, a group can be physicians or not, or a mix, and a group can be one guy. And these two taxonomy codes aren't in the providers' taxonomy code data. Oh, and providers can report these same two codes up to 15 times (presumably having some relation to the up to 15 taxonomy codes in that other section of the data?) And, given 15 fields to play with, they can report being both a single specialty group and a multi-specialty group.
Hrrmph.
And there just happens to be many more group practices out there than are reported via these codes.
Using the new group codes data to actually identify groups, then, is somewhat less than doable. So we've taken a different tack.
Many of our clients need to know the group status of an individual practitioner. Let's take some really common examples. Let's say you are putting together a clinical trial for a new drug, or a marketing campaign for a new device. By phone, fax, and/or mail, you plan to contact a few thousand physicians in this state, a few thousand in that state, etc. You don't want to deluge a practice with 50 letters or phone calls all at once (and some practice locations are that big and bigger), so you need to know the practice group for the physicians on your list, so you can stagger your communications. Or, let's say, you just want to reach the CEO or medical director for a given group. Well, as it happens, the CEOs isn't always the record that indicates a group practice; it's sometimes the office manager, credentialing coordinator, or just a young doc who can pilot the laptop. How do you sort all this out? Well, frankly, you couldn't, until now.
Beginning this month the CarePrecise Access dataset contains a new feature called a "CoLoCode" (co-location code). The CoLoCode is derived from deeply conformed practice location data, and each provider record gets one. Look up a group (using the CMS Group codes or by looking for a number of physicians co-located at the same practice address), then plunk that CoLoCode into a query to show you all the providers practicing at that location. Voila!
To make it even easier, we are releasing a new version of our CP ListMaker software, with new group features that take full advantage of the CoLoCodes and new CMS group data.
CMS Redacts NPI in PECOS File: Solution
The PECOS Ordering and Referring Report has been a tremendous resource for those of us who have to know whether a business partner is eligible to bill Medicare. A great example is the DME supplier who needs to know that the physician who orders a patient's medical equipment is authorized to do that; could cost him money when the claim is rejected. Well, that report has just gotten a mite less useful.
(UPDATE: Here's a press release we just sent on this issue, and a page on our website with details.)
Starting with the current release, CMS has blocked out the first 6 digits of the NPI number. It looks like ******1234. Utterly useless if you want to incorporate that file into your business systems. We have a solution!
CarePrecise specializes in healthcare record linkage projects. We collect data files from many sources and, using our QoRelate record "linking and shrinking" system, match them into our NPI database. The PECOS Ordering and Referring Report and the pending enrollment files are no exception. Our system can still tell you which providers are enrolled to bill Medicare or have a pending enrollment -- with their NPI number and a lot of additional information the PECOS reports never offered.
In fact, we not only match up NPI numbers with PECOS enrollment, we also do it with the federal List of Excluded Providers (LEIE), the now deprecated but still useful UPIN registry, state license numbers, phone and fax numbers, both mailing and practice addresses, economic data from the US Dept of Commerce, and much more. Now we can even tell you how many providers practice at the same location, and give you the providers who report as a multi-specialty or single specialty practice group.
It's all in CarePrecise Gold (and everything except the economic data is in our basic dataset, CarePrecise Access), for 3.5 U.S. healthcare million providers.
(UPDATE: Here's a press release we just sent on this issue, and a page on our website with details.)
CarePrecise specializes in healthcare record linkage projects. We collect data files from many sources and, using our QoRelate record "linking and shrinking" system, match them into our NPI database. The PECOS Ordering and Referring Report and the pending enrollment files are no exception. Our system can still tell you which providers are enrolled to bill Medicare or have a pending enrollment -- with their NPI number and a lot of additional information the PECOS reports never offered.
In fact, we not only match up NPI numbers with PECOS enrollment, we also do it with the federal List of Excluded Providers (LEIE), the now deprecated but still useful UPIN registry, state license numbers, phone and fax numbers, both mailing and practice addresses, economic data from the US Dept of Commerce, and much more. Now we can even tell you how many providers practice at the same location, and give you the providers who report as a multi-specialty or single specialty practice group.
It's all in CarePrecise Gold (and everything except the economic data is in our basic dataset, CarePrecise Access), for 3.5 U.S. healthcare million providers.
December 24, 2011
Five Steps to EHR: A .Gov Primer
Now that electronic health record software is a virtual necessity for a productive practice, HealthIT.gov offers a common-sensical five-step plan for implementing EHR in a practice. A number of years ago, we worked with the national Blue Cross and Blue Shield Association to create a case-based analysis of the EHR scenario. That publication outlined the efforts of many practices to incorporate EHR into multi-physician practcies. Check out the current wisdom at HealthIT.gov.
October 10, 2011
Phone Messaging: New Channel to Physicians
It's wildly hit-and-miss -- much like email spam -- but marketers are increasingly using bulk text messaging to penetrate the armor cladding of physician offices. And it's a wide open opportunity; physician office phone numbers are openly published, unlike email addresses. Fax numbers are available too (CarePrecise provider data includes both phone and fax numbers, up to four numbers per record, and we know that it is widely used for marketing to physicians), but "faxpam" doesn't have the same high-tech glamor. Unlike a fax broadcast, text messaging allows marketers to embed a live link to a web landing page, as well as an instantly accessible means for recipients to opt out, making bulk SMS marketing just a little bit more respectable. (Ever tried to get a faxpammer to stop? Ha!)
So what's the difference between bulk SMS cold-calling and plain old spam? Not much, except that it's newer and less fraught with sleaze. And here's something more: It's not free, so spammers can't just set up a computer and start sending 100 million spam messages a day at essentially no cost. Text messaging to phones requires that you have an SMS gateway, or an account with a service provider who has one. These are available to bulk senders, but at a price. Okay, it's not exactly postage, but it's at least a price.
Among the numerous offerings for bulk SMS gateway and software services are Mobomix and TXTwire. Both offer essentially unlimited sending with premium accounts, but both enforce opt-in requirements. That is, you can't just upload a database of phone numbers, such as the 5 million or so in the CarePrecise database, and start texting. Instead, these services require that you are sending only to your own customers or others who have explicitly said, "Yeah, okay, text me spam."
Of course, there's always a workaround. Another company, SMScountry, offers an Excel plug in that lets you send personalized text messages. While they have a similar anti-spam policy, the way the system works would make it difficult to police. As with all bulk SMS systems, it isn't particularly easy for a recipient to contact the carrier to complain. The carrier backbone for SMS is a bit primitive compared with that of email, and there are fewer hooks for filtering messages by the carriers, should they ever want to do what ISPs are doing about email spam. It's pretty much up to the owner of the gateway.
In the war between marketers and physicians, both sides escalate as new weapons or defenses arise. A fax isn't likely to ever see a doctor's spectacles, but that same unreachable physician isn't really that unreachable if you can get his email address or phone number. Naturally, it helps to have her mobile number rather than just the office phone, for obvious reasons. But if you've got a product to sell to docs, any opening is a huge gaping hole, and, even if the text message gets converted to a computer-voiced voice mail message, and, even if only the smallest percentage reach a bona fide phyz, maybe paying $60 a month for a bulk gateway account with few limits sounds good to you. And a good many of those published numbers are cell phones, some portion of them presumably reaching right into a doctor's pocket.
Bulk SMS has its Whitehat side, of course. Services that allow you to enter your customers' account info and send text billing notices, patient appointment reminders, among a host of other applications, are opening up the commercial use of phone messaging. I opted in for a J.C. Penney's coupon texting service, and I use it.
But let's say you've got a nice big customer list, folks who freely gave you their phone numbers (long before the advent of SMSpam, but still...). Can you send em all a coupon, or a new product announcement, or an offer of a free EHR assessment? I want to say no, but we send these same customers more-or-less "unsolicited" email, at least in the sense that they never explicitely said "Send me your coupons," but something more like "Send me product update notices via your monthly newsletter." That phone number was optional, right? Houston, we have achieved opt-in.
Certain advantages of smartphones, such as the ability to blacklist messagers, are a helpful control. The barriers to entry are currently very high for an SMSpammer who wants to set up his own unrestricted gateway, so he'll be using these third party services and, perhaps, have to behave himself. But look for text marketing to grow wildly in the near future.
Check out our page on Marketing to Healthcare Providers.
So what's the difference between bulk SMS cold-calling and plain old spam? Not much, except that it's newer and less fraught with sleaze. And here's something more: It's not free, so spammers can't just set up a computer and start sending 100 million spam messages a day at essentially no cost. Text messaging to phones requires that you have an SMS gateway, or an account with a service provider who has one. These are available to bulk senders, but at a price. Okay, it's not exactly postage, but it's at least a price.
Among the numerous offerings for bulk SMS gateway and software services are Mobomix and TXTwire. Both offer essentially unlimited sending with premium accounts, but both enforce opt-in requirements. That is, you can't just upload a database of phone numbers, such as the 5 million or so in the CarePrecise database, and start texting. Instead, these services require that you are sending only to your own customers or others who have explicitly said, "Yeah, okay, text me spam."
Of course, there's always a workaround. Another company, SMScountry, offers an Excel plug in that lets you send personalized text messages. While they have a similar anti-spam policy, the way the system works would make it difficult to police. As with all bulk SMS systems, it isn't particularly easy for a recipient to contact the carrier to complain. The carrier backbone for SMS is a bit primitive compared with that of email, and there are fewer hooks for filtering messages by the carriers, should they ever want to do what ISPs are doing about email spam. It's pretty much up to the owner of the gateway.
In the war between marketers and physicians, both sides escalate as new weapons or defenses arise. A fax isn't likely to ever see a doctor's spectacles, but that same unreachable physician isn't really that unreachable if you can get his email address or phone number. Naturally, it helps to have her mobile number rather than just the office phone, for obvious reasons. But if you've got a product to sell to docs, any opening is a huge gaping hole, and, even if the text message gets converted to a computer-voiced voice mail message, and, even if only the smallest percentage reach a bona fide phyz, maybe paying $60 a month for a bulk gateway account with few limits sounds good to you. And a good many of those published numbers are cell phones, some portion of them presumably reaching right into a doctor's pocket.
Bulk SMS has its Whitehat side, of course. Services that allow you to enter your customers' account info and send text billing notices, patient appointment reminders, among a host of other applications, are opening up the commercial use of phone messaging. I opted in for a J.C. Penney's coupon texting service, and I use it.
But let's say you've got a nice big customer list, folks who freely gave you their phone numbers (long before the advent of SMSpam, but still...). Can you send em all a coupon, or a new product announcement, or an offer of a free EHR assessment? I want to say no, but we send these same customers more-or-less "unsolicited" email, at least in the sense that they never explicitely said "Send me your coupons," but something more like "Send me product update notices via your monthly newsletter." That phone number was optional, right? Houston, we have achieved opt-in.
Certain advantages of smartphones, such as the ability to blacklist messagers, are a helpful control. The barriers to entry are currently very high for an SMSpammer who wants to set up his own unrestricted gateway, so he'll be using these third party services and, perhaps, have to behave himself. But look for text marketing to grow wildly in the near future.
Check out our page on Marketing to Healthcare Providers.
September 28, 2011
September 21, 2011
Nifty Licensing Agency Contact Resource
Want to know who the various healthcare provider licensing entities are for a given state? Palmetto GBA has made that a piece of cake now. Their new database of licensing requirements (primarily for use by DME suppliers) includes the licensing bodies for each state. For example, here's what they show for New York:
Another table shows the type of provider with a link to the number (as listed above), and still another nifty feature lets you choose a healthcare product or service from a dropdown, and jumps you to a listing of the various licensing requirements. Kudos!
| 1) | New York State Board of Pharmacy Phone: 518-474-3817 extension 130 extension 130 Web: http://www.op.nysed.gov/prof/pharm/ - Registered Pharmacy Establishment Certificate |
| 2) | New York State Board of Pharmacy, Office of the Professions Phone: 518-474-3817 extension 250 extension 250 Web: http://www.op.nysed.gov/prof/od/ - Ophthalmic Dispenser License |
| 3) | New York State Board of Respiratory Therapy Phone: 518-474-3817 extension 120 extension 120 Web: http://www.op.nysed.gov/prof/rt/ - Respiratory Therapist |
| 4) | New York State Education Department, Office of the Professions Phone: 518-474-3817 extension 591 extension 591 Web: http://www.op.nysed.gov/prof/ - Optometrist License - Physician License |
| 5) | New York Department of Health Phone: 518-402-1016 Web: http://www.nyhealth.gov/ - Ambulatory Surgical Center - Home Health License - Hospital License - Nursing Home Administrator License - Nursing Home License |
Another table shows the type of provider with a link to the number (as listed above), and still another nifty feature lets you choose a healthcare product or service from a dropdown, and jumps you to a listing of the various licensing requirements. Kudos!
HIPAA Hacked: ALL YOUR MEDICAL RECORDS ARE BELONG TO US
#sslsecurityhack SSL/TLS, the encryption system that has been keeping online credit card transactions and HIPAA-sensitive communications safe for over a decade, has broken down. As shown by researchers at a recent conference, a simple tool now gives hackers access to your PayPal transactions and much more. Gonna be fixed? Possibly not for many months, even years, since any change to the SSL/TLS protocols causes ecommerce to break for any number of sites, depending on the server or browser involved in the transaction. The hack is truly a killer app.Just google SSL/TLS HIPAA and you'll find hundreds of applications that use Secure Sockets Layer/Transport Layer Security technology to secure electronic medical records transactions. (Here's an ironic example of the misinformation out there, labeled "Completely Secure Collection of Web Form Data using SSL".)
An article in The Register reports that a couple of researchers announced a demo of their tool, called BEAST (Browser Exploit Against SSL/TLS), at a Buenos Aires security conference last week. BEAST performs a "plaintext-recovery" attack, exploiting a (previously theoretical, but known) weakness in TLS. During encryption, the TLS protocol scrambles each subsequent block of data based on the previous encrypted block. It had long been theorized that an attack could manipulate the process to make educated guesses about the contents of the plaintext blocks. If a guess is correct, the block cipher will get the same hash for a new block as it used for the previous one, resulting in identical cipher-text. Security just goes POOF.
At the moment, BEAST requires a little under two seconds to decrypt each byte in an encrypted cookie, used by a web browser to secure an online transaction session. Doing the math, a 1,000-byte cookie would take maybe half a minute, but researchers Thai Duong and Juliano Rizzo have now announced that they've tweaked the process down to about ten seconds. That's plenty quick to grab whatever users are sending, decypher it, and, well, steal it.
So, what are browser makers doing to plug this new hole? One word: Nothing. What's the hold up? Well, although this "theoretical" hack has been understood for years, a secure transaction involves just too many parties to get it all straightened out without knocking out millions -- perhaps billions -- of transactions for perhaps an extended period of time. For instance, the Firefox and Chrome browsers (according to w3schools.com, Firefox gets 40.6% of traffic, while Internet explorer gets just 22.4%, and Google Chrome gets 30.3% as of August, 2011) use the open source Network Security Package to implement HTTPS. But there are other security packages out there, and IE uses one of them. Any change would require simultaneous change to all packages. And that's not the half of it; the servers use multiple SSL implementation platforms, such as OpenSSL, and all of those would have to change at the same time. The offending protocol, TLS 1.0, has been available in an upgraded version (1.1 and 1.2) since 2006, but getting all the ducks lined up just isn't happening. While IE 8 and up include support for TLS 1.1 and 1.2, which do not appear to have the vulnerability, it is not the default, and still relies on servers to accept the protocols without falling back to 1.0.
“The problem is people will not improve things unless you give them a good reason, and by a good reason I mean an exploit... It's terrible, isn't it?” said an analyst with the security firm Qualys.
There appear to be no reliable estimates of the percentage of HIPAA electronic transactions that are secured using SSL with TLS 1.0, but considering that, in the absence of a broadly implemented general browser-server solution, any TLS v1.2 implementations would require proprietary code at both the server and client sides, and transactions running under the hackable version would likely be the overwhelming majority. As of early 2011, Microsoft's .Net framework did not support the updated TLS protocols, suggesting that any EMR, EHR, eligibility and billing applications developed at that time may not support them either. Time to call your vendor?
Check Comments below for updates...
September 11, 2011
91 Charged With $295 Million Medicare Fraud
Ninety-one doctors, nurses and others were charged in a blockbuster sting operation, with arrests unfolding over three weeks and culminating in 70 arrests last week. In 2007, a strike force was set up between the Department of Justice and the Department of Health and Human Services to identify and build federal fraud cases to fight criminal abuse of federal healthcare programs. U.S. Attorney General Eric Holder said that arrests were made in eight US cities involving more than $295 million in stolen funds.
Almost half of those charged were part of a Florida ring that recruited healthcare providers to refer patients to a mental health center, in some cases threatening residents of a halfway house with eviction if they refused the unnecessary care. Another case involved $3.4 million in unnecessary physical therapy by two Brooklyn physicians.
On September 1, officials in Detroit charged 18 physicians, nurses, clinic owners and other medical professionals for submitting $28 million in false claims to Medicare. Just one day earlier, the owner of a Houston, Texas durable medical equipment business was sentenced to 97 months in prison for his role in a Medicare fraud scheme.
In all, the strike force, known as Health Care Fraud Prevention and Enforcement Action Team (HEAT), has charged 1,140 defendants who collectively have falsely billed the Medicare program for more than $2.9 billion.
When providers have been convicted of fraud and certain other infractions and delinquencies, their names are placed on the List of Excluded Individuals/Entities (LEIE) database. CarePrecise compiles this data into its comprehensive database of U.S. healthcare providers, identifying excluded providers' NPI numbers, phone and fax numbers.
Read the full story on the HHS website.
Almost half of those charged were part of a Florida ring that recruited healthcare providers to refer patients to a mental health center, in some cases threatening residents of a halfway house with eviction if they refused the unnecessary care. Another case involved $3.4 million in unnecessary physical therapy by two Brooklyn physicians.
On September 1, officials in Detroit charged 18 physicians, nurses, clinic owners and other medical professionals for submitting $28 million in false claims to Medicare. Just one day earlier, the owner of a Houston, Texas durable medical equipment business was sentenced to 97 months in prison for his role in a Medicare fraud scheme.
In all, the strike force, known as Health Care Fraud Prevention and Enforcement Action Team (HEAT), has charged 1,140 defendants who collectively have falsely billed the Medicare program for more than $2.9 billion.
When providers have been convicted of fraud and certain other infractions and delinquencies, their names are placed on the List of Excluded Individuals/Entities (LEIE) database. CarePrecise compiles this data into its comprehensive database of U.S. healthcare providers, identifying excluded providers' NPI numbers, phone and fax numbers.
Read the full story on the HHS website.
September 9, 2011
U.S. Doctors Earn Big, Drive Up Costs
According to a new study published in Health Affairs, America's approximately 1.1 million physicians are paid dramatically higher fees than those in all of the other more than 230 Organisation for Economic Co-Operation and Development countries. Per capita, our physicians are paid $1,599; other countries averaged significantly less than that -- about 81% less -- or about $310. The difference, nearly $1,300, is a major factor in driving up U.S. healthcare costs, and, according to the report, is the the main cause of higher overall spending in America on physicians' services.
The disparity comes into stark focus in the area of specialists' fees. While U.S. primary care docs earned significantly higher than their foreign counterparts -- averaging $186,582 annually -- orthopedic physicians earned $442,450. As an example, the study compared physicians’ fees paid by public and private payers for hip replacements in Australia, Canada, France, Germany, the United Kingdom, and the United States, finding that much higher fees were paid to U.S. orthopedic physicians for hip replacements (70 percent more for public payers, 120 percent more for private payers) than public and private payers paid these specialitsts in other countries. The study concludes that "the higher fees, rather than factors such as higher practice costs, volume of services, or tuition expenses, were the main drivers of higher U.S. spending, particularly in orthopedics."
According to August, 2011 CarePrecise data, of the approximately 1.1 million U.S. physicians, about 35,500 practice as orthopedists and orthopedic surgeons, with another 378,000 specialists practicing in the high fee taxonomies. Only about 160,000 U.S. physicians serve in family practice.
The disparity comes into stark focus in the area of specialists' fees. While U.S. primary care docs earned significantly higher than their foreign counterparts -- averaging $186,582 annually -- orthopedic physicians earned $442,450. As an example, the study compared physicians’ fees paid by public and private payers for hip replacements in Australia, Canada, France, Germany, the United Kingdom, and the United States, finding that much higher fees were paid to U.S. orthopedic physicians for hip replacements (70 percent more for public payers, 120 percent more for private payers) than public and private payers paid these specialitsts in other countries. The study concludes that "the higher fees, rather than factors such as higher practice costs, volume of services, or tuition expenses, were the main drivers of higher U.S. spending, particularly in orthopedics."
According to August, 2011 CarePrecise data, of the approximately 1.1 million U.S. physicians, about 35,500 practice as orthopedists and orthopedic surgeons, with another 378,000 specialists practicing in the high fee taxonomies. Only about 160,000 U.S. physicians serve in family practice.
August 4, 2011
And They Were So Close to Canada!
Looks like some Medicare patients will go to any lengths to escape the high cost of U.S. prescription drugs. Even if only through opium-induced euphoria.
Michigan: Twenty-six persons have been charged by Federal investigators in a Medicare fraud scam that took in more than $58 million in fraudulent billings and illegally acquired more than 6 million doses of pricy medications. Drugs were used to entice Medicare patients to play along.
The brains of the gang, one Babubhai Patel, ran a network of 26 Michigan pharmacies that bribed physicians to write the prescriptions, many of them opiates and other frequently-abused pharmaceuticals. Physicians recruited grandmas as mules. Medicare patients would knowingly fill the illicit prescriptions, keeping the drugs and handing over their Medicare and Medicaid billing information to the conspirators. Four doctors and ten pharmacists, as well as some of the patients and others, were indicted in the federal grand jury action.
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