From the lawyer-published “Healthcare Compliance Blog:”
I predict that the DOJ will be:
1.Continuing its efforts to deal with providers in an open and collaborative manner.
2.Notifying more hospitals that they are under investigation relating to ICD billing.
3.Making additional inquiries of hospitals regarding this matter.
4.Investigating doctors who have patterns of high ICD implantation rates, coupled with a potential lack of medical necessity. The medical necessity issue poses risks to both physicians and hospitals.
These are not really hard predictions to make, though I would argue that the DOJ has been anything but “open and collaborative” as they have imposed a gag order on the Heart Rhythm Society during their current investigation.
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But we must acknowledge there are implanters who have scammed the system and they should be held accountable for their actions. But for the myriad of physicians who are implanting devices appropriately, no one quite knows what to do with their patients since the government’s CMS-directed guidelines are so out of date. As I mentioned before, CMS wants doctors to use their ICD guidelines based on data from 2005 that ignores the more recently published (and less restrictive) guidelines published in 2008.
We are now seeing the Draconian and covert methods that will be used to impose restrictions on our patients’ care. This model will serve the government operatives for other expensive technologies, too, like hip replacements, spinal fusions, and the like.
Whether the government begins to prosecute doctors for using the newer ICD implantation guidelines remains to be seen, but the mere specter that they’re looking has already achieved the government’s goal since no one whats the expense and notoriety of a legal investigation to contend with and as a result, ICD implantation rates are currently dramatically reduced.
Mission accomplished.
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Westby G. Fisher, MD, FACC is a board certified internist, cardiologist, and cardiac electrophysiologist (doctor specializing in heart rhythm disorders) practicing at NorthShore University HealthSystem in Evanston, IL, USA and is a Clinical Associate Professor of Medicine at University of Chicago's Pritzker School of Medicine. He entered the blog-o-sphere in November, 2005. He writes regularly at Dr. Wes. DISCLAIMER: The opinions expressed in this blog are strictly the those of the author(s) and should not be construed as the opinion(s) or policy(ies) of NorthShore University HealthSystem, nor recommendations for your care or anyone else's. Please seek professional guidance instead.
