The three top recipients of Medicare reimbursements for unclassified drug injections are at a single clinic in Alabama, according to a Washington Post article published May 10 about how recently released Centers for Medicare and Medicaid Services (CMS) Medicare payment data can be used to identify “hotspots” for particular treatments. The article said that the Alabama Pain Center and its owner, Dr. K. Dean Willis, an anesthesiologist, and two other physicians at the clinic were the top three recipients nationally for Medicare payments for unclassified injections. The Post article went on to describe how the clinic has been the subject of a 16-month audit by a Medicare contractor and a court filing by Blue Cross and Blue Shield of Alabama accusing the clinic of fraudulent billing practices. That intense scrutiny had forced the clinic to the brink of closure after Medicare began denying its payments to the clinic for issues related to the unclassified injections. Two of the physicians have left the Alabama clinic and started pain clinics of their own. The clinic rallied its patients to their cause asking them to write letters to their representatives in the government, and payments were restored. In the April issue of G2 […]
The three top recipients of Medicare reimbursements for unclassified drug injections are at a single clinic in Alabama, according to a Washington Post article published May 10 about how recently released Centers for Medicare and Medicaid Services (CMS) Medicare payment data can be used to identify “hotspots” for particular treatments.
The article said that the Alabama Pain Center and its owner, Dr. K. Dean Willis, an anesthesiologist, and two other physicians at the clinic were the top three recipients nationally for Medicare payments for unclassified injections.
The Post article went on to describe how the clinic has been the subject of a 16-month audit by a Medicare contractor and a court filing by Blue Cross and Blue Shield of Alabama accusing the clinic of fraudulent billing practices. That intense scrutiny had forced the clinic to the brink of closure after Medicare began denying its payments to the clinic for issues related to the unclassified injections. Two of the physicians have left the Alabama clinic and started pain clinics of their own. The clinic rallied its patients to their cause asking them to write letters to their representatives in the government, and payments were restored.
In the April issue of G2 Compliance Advisor, we discussed the CMS data dump and its potential for causing increased scrutiny from the press and the public as the information is studied by newspapers and others. In this case, the Post article revealed the troubles this clinic has experienced after studying the data CMS released.
There is a lesson for laboratories and all other providers in the Post article: As the government continues its quest for transparency in how health care services are provided and paid for, many more providers may find themselves the subject of increased scrutiny by not only the government but by their patients and their peers.
Takeaway: Laboratories should study the data contained in the CMS data release that relates to their business and industry to determine potential troublespots.
