HHS Subpoenas Records at Maryland Hospital

News and Commentary
HHS Subpoenas Records at Maryland Hospital - - Thu Jun 17, 02:01 pm GMT [News4Sites Healthcare] Maryland General Hospital is under investigation for conducting and billing for inaccurate lab tests.

Big Employers Join Forces in Effort to Negotiate Lower Drug Prices

News and Commentary
Big Employers Join Forces in Effort to Negotiate Lower Drug Prices - To slow the rising cost of health coverage, 50 of the country’s largest employers are creating a buyers’ club to bargain directly with drug makers. [New York Times Healthcare News] I couldn’t help noticing that while many Medicaid programs pay AWP minus 10%, the price at the drugstore (for the example mentioned in the article) was below that price.

Medical Journals May Force Disclosure of Bad Trials

News and Commentary
Medical Journals May Force Disclosure of Bad Trials - WASHINGTON (Reuters) - Editors of the leading medical journals are considering a proposal that would make drug companies disclose trials that shed unfavorable light on their products, The New York Times reported on Tuesday. [Reuters Health News] This development can give Evidence Based Medicine researchers the information they need to evaluate new drugs.

A Study Questions Blood-Test Results on Prostate Cancer

News and Commentary
A Study Questions Blood-Test Results on Prostate Cancer - Significant numbers of older men whose results on a popular screening test for prostate cancer are normal may nonetheless have cancer. [New York Times Healthcare News]

This New York Times article reminds us that we have to be careful how we interpret cancer screening results. Early detection of cancer can lead to unnecessary interventions. The study showed that 15% of men with PSAs below 4 had cancer. The study could lead some doctors and patients to conclude that a biopsy makes sense, even with low PSA. However, the article also says:

May 2004 Newsletter


The Month’s Report:

  • Ten Steps to Stop Healthcare Fraud
  • Fraud Control Toolbox
  • Updated Bidding Opportunities
  • Public Appearances

Ten Steps to Stop Healthcare Fraud

Fraud is a serious problem that affects every healthcare system. Each health plan loses from 3% to 30% to fraud, waste and abuse. Reducing fraud losses is one of the few ways that a health plan can cut costs without hurting their members or providers. Investment in fraud control typically saves $6 to $12 for every dollar spent, yet health systems have not invested in the level of controls that will effectively stop fraud. Check out these ten steps that will help you stop fraud.

State Bidding News: Wisconsin, Colorado, Iowa

News and Commentary

Wisconsin and Colorado have released RFPs. Iowa is going to announce decisions by the end of the month about its Medicaid Enterprise Systems & Professional Services contract awards.

Wisconsin Medicaid Fiscal Agent Contract Procurement

The Department of Health and Family Services (DHFS), Division of Health Care Financing, announced issuance of the Request for Proposals (RFP) to procure a new Medicaid Management Information System (MMIS) and Fiscal Agent services contract to meet the informational, operational, and administrative needs of the day-to-day management of the $3.8 billion Wisconsin Medicaid program and other DHFS programs. The RFP was issued on VendorNet on April 29, 2004 and is posted at their website. Proposals are due July 27, 2004 by 4:00 PM CDT.

Studies Question Effectiveness of Artery-Opening Operations

News and Commentary

Studies Question Effectiveness of Artery-Opening Operations - A new and emerging understanding of how heart attacks occur indicates that increasingly popular aggressive treatments may be doing little or nothing to prevent them. [New York Times Healthcare News]

This article helps shine some light on the Tenet case of Redding cardiologists who have been accused of performing hundreds of unnecessary bypass surgeries. In Redding, the cardiology center aggressively marketed heart surgery as preventive care. This article cites studies of the ineffectiveness of bypasses and stents as preventive measures and describes how cardiologists end up putting their financial interests above their patients’ interests.

Doctor charged with health care fraud

News and Commentary
Doctor charged with health care fraud - - Wed Mar 17, 07:24 am GMT [News4Sites Healthcare] A Nashville, TN doctor has been charged with Medicare fraud. This is a little reminder that healthcare fraud is everywhere, not just in New York, New Jersey, Florida and California. As more claims are submitted electronically (particularly in a growing trend of web-based claim submission), it is not even necessary for criminals committing fraud to live in the same state as the agency they are defrauding. As New York, New Jersey, Florida and California get better at finding fraud, you should expect fraud to be exported to other areas of the country. It is easier for criminals to continue using the same scams with different targets that to come up with new scams.

March 2004 Newsletter


This Month’s Report:

  • The Art of Deception
  • Growth Hormone Bust
  • Data Warehousing
  • Appearances

The Art of Deception

I’m reading “The Art of Deception” by Kevin Mitnick, a famous hacker. You’ve got to read this book. You’ll learn to take security a lot more seriously. Mitnick describes scam after scam that involve social engineering—tricking people into thinking they should give you information. The lesson is that all the systems in the world won’t stop fraud by themselves. Only people can stop fraud.

Most of the scams he describes do not require a computer. The scams work by convincing people that the scam artist is somebody they should trust, such as the vice president in the LA office, the security consultant or some coworker you’ve never met. They provide just enough believable information to get the next bit of information they need for their scam. Read more.

New Data Sought in Federal Probe of Tenet

News and Commentary

New Data Sought in Federal Probe of Tenet - Los Angeles Times Mar 4 2004 8:27AM GMT [Healthcare Management News]

Tenet is in trouble again. This time it’s about possible kickback arrangement with physicians in Texas. Tenet is the second largest hospital chain in the US. This allegation is just one more of many that have been brought in the past few years. I’ve written several articles about Tenet and talked about some of the issues in an interview on CNBC. Read the other articles

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