CAPITAL PHYSICIAN REPORT ARCHIVES

Friday, November 30, 2007

Well, the trial bar is out in force and the news media is blindly following their lead. You can watch one example HERE. (Look for video labeled Malpractice Mess)

I really don't think that these reporters understand what is going on behind closed doors.

posted at 11:05 A.M. by Jonathan H. Dougherty, M.S.

Wednesday, November 14, 2007

LIABILITY ALERT!

NYS Insurance Superintendent Dinallo WILL dramatically increase medical liability rates beginning July 1, 2008 unless meaningful tort reform is passed in the Legislature next year. We have a MSSNY briefing on Tuesday, November 27th beginning at 5:30 P.M. at the Italian American Community Center. We need 100 people or more to attend so that we can send a message to our elected officials and the media that if these increases go through we will see mass retirement of physicians in New York!

YOU CAN DOWNLOAD A PDF ANNOUNCEMENT HERE. YOU CAN MAKE RESERVATIONS TO ATTEND HERE.

posted at 2:37 P.M. by Jonathan H. Dougherty, M.S.

Wednesday, November 7, 2007

LIABILITY ALERT!

WE WILL BE HOLDING A JOINT MEMBERSHIP MEETING OF THE MEDICAL SOCIETY OF THE COUNTY OF ALBANY, INC. AND THE ALBANY AFFILIATE OF THE NEW YORK MEDICAL GROUP MANAGEMENT ASSOCIATION ON TUESDAY, NOVEMBER 27, 2007 AT THE ITALIAN AMERICAN COMMUNITY CENTER, 250 WASHINGTON AVENUE EXTENSION, ALBANY BEGINNING AT 5:30 P.M. THE TOPIC WILL BE TO DISCUSS NYS INSURANCE SUPERINTENDENT ERIC DINALLO'S INTENTIONS TO DRAMATICALLY INCREASE MEDICAL LIABILITY RATES IN NEW YORK STATE.

YOU CAN DOWNLOAD A PDF ANNOUNCEMENT HERE. YOU CAN MAKE RESERVATIONS TO ATTEND HERE.

posted at 10:49 A.M. by Jonathan H. Dougherty, M.S.

Tuesday, November 6, 2007

LIABILITY ALERT!

Go HERE for a Liability Alert pdf file.

posted at 11:35 A.M. by Jonathan H. Dougherty, M.S.

Thursday, November 1, 2007

PATRICK FLANIGAN:

During the hearing, State Sen. Neil Breslin, D-Albany County, promised to follow through on the suggestion of a Yates County physician, who said insurance providers should obtain authorization from the state Insurance Department before creating such pre-certification programs.

Radiology pre-authorization may be coming to Albany soon!

posted at 11:46 A.M. by Jonathan H. Dougherty, M.S.

Wednesday, October 31, 2007

Happy Halloween!

posted at 10:43 A.M. by Jonathan H. Dougherty, M.S.

Thursday, October 25, 2007

CHARLES BABINGTON:

WASHINGTON (AP) - House members are about to learn whether some nips and tucks to a children's health bill will be enough to secure a veto-proof margin against a White House that wants major surgery.

posted at 10:26 A.M. by Jonathan H. Dougherty, M.S.

Monday, October 22, 2007

CATHLEEN F. CROWLEY:

"But at the end of the day, whether you will be able to compare surgery at Albany Med to surgery at St. Peter's, I don't know if you will be able to use the numbers that way."

posted at 2:14 P.M. by Jonathan H. Dougherty, M.S.

Thursday, October 18, 2007

ATTORNEY GENERAL CUOMO CALLS ON HEALTH CARE COMPANIES TO HALT PLANNED DOCTOR RANKING PROGRAMS

DIRECTS EMPIRE BLUE CROSS BLUE SHIELD TO DISCLOSE BASIS FOR DOCTOR RANKINGS

Issues Consumer Alert To New Yorkers about Potentially Deceptive Programs

NEW YORK, NY (Oct 18, 2007) – In an expanding industry-wide investigation, New York Attorney General Andrew M. Cuomo today issued letters to Empire Blue Cross Blue Shield, Preferred Care, and HIP Health Plan of New York/GHI requesting information on the insurers’ doctor ranking programs. The Attorney General also alerted New Yorkers about potentially deceptive programs driven by financial motives and not consumers’ best interests.

“Consumers need to be aware that doctor ranking programs as currently designed may steer patients to the cheapest, but not necessarily the best doctors, letting profits trump quality,” said Attorney General Andrew Cuomo. “Transparency and accurate information are critical when making health care decisions and should not be clouded by conflicts of interest.”

In the three separate letters sent today, Attorney General Cuomo:

• Requested New York City-based Empire Blue Cross Blue Shield to justify its existing ranking program known as Blue Precision, currently offered to national employers in New York City.
• Directed Rochester-based Preferred Care to halt the launch of its planned doctor ranking program and to provide details about the system.
• Warned New York City-based HIP Health Plan/GHI to refrain from launching such programs without the prior consent of the Attorney General.

In the letter to Empire Blue Cross Blue Shield, serving approximately 533,271 members across New York State, Cuomo also questioned Blue Precision’s strategy to steer consumers to preferred doctors. In a publicly available presentation outlining the program, Empire describes its “sanction” model which pressures consumers to switch doctors by imposing financial penalties.

Blue Precision is expected to be operating in 22 states by 2008. The program is already available to national employers such as Wal-Mart, which has deployed the program in Florida.

“When making healthcare decisions, it is vital consumers have as much honest information and unfiltered advice as possible,” said Cuomo. “Ranking systems are in their infancy. Consumers should use caution and have an open dialogue with their doctors.”

In the letter to Preferred Care, serving approximately185,188 members across New York State, Cuomo also cited concern about the insurers’ "report cards," which include a measure of patient satisfaction based in large part on cost criteria.

Attorney General Cuomo is scrutinizing the emerging national trend of physician ranking programs in an effort to ensure consumers are protected. Similar letters have been sent to UnitedHealthcare, Aetna Health Plan, and Cigna in recent weeks, and discussions with these companies are ongoing.

(Thanks to Nancy Adams, Executive Director of the Monroe County Medical Society, for providing us this information.)

posted at 2:20 P.M. by Jonathan H. Dougherty, M.S.

Wednesday, October 10, 2007

SCOTT WEINBERGER:

PALISADES, N.J. (CBS) ?Just weeks after George Clooney was injured in a motorcycle accident and taken to Palisades Medical Center, CBS 2 HD has exclusively learned that dozens of employees, including doctors and nurses, have been suspended for accessing Clooney's confidential information.

posted at 7:39 A.M. by Jonathan H. Dougherty, M.S.

Wednesday, September 26, 2007

DR. EDWARD BRANDOW, JR. has died. He was 85. Dr. Brandow was a long-time member of the Medical Society and was quite active even in his latter years. RIP.

posted at 10:58 A.M. by Jonathan H. Dougherty, M.S.

ALAN WECHSLER:

TROY -- It was a fairly simple surgery: a small incision in the hand to relieve the swelling that causes carpal tunnel syndrome.

But the technology behind the surgery -- the tiny cameras that showed doctors the inside of the hand, the devices that monitor blood oxygen levels, the equipment that pumps an anesthetic and nerve-blocker -- was about as high-tech as a same-day surgery can get.

Alan's article discusses a video presentation to RPI engineering students by Dr. Richard Uhl of the BONE AND JOINT CENTER.

posted at 10:32 A.M. by Jonathan H. Dougherty, M.S.

Monday, September 24, 2007

Love her or hate her, ANN COULTER has written a terrific piece on what it's like to be a doctor in America:

The only "crisis" in health care in this country is that doctors are paid too little.

Now that's something you don't read everyday!

posted at 9:50 A.M. by Jonathan H. Dougherty, M.S.

Tuesday, September 18, 2007

BETH FOUHY:

WASHINGTON - Democrat Hillary Rodham Clinton said Tuesday that a mandate requiring every American to purchase health insurance was the only way to achieve universal health care but she rejected the notion of punitive measures to force individuals into the health care system.

posted at 3:55 P.M. by Jonathan H. Dougherty, M.S.

NEW YORK ONCOLOGY HEMATOLOGY and the Albany Medical College are holding a day-and-a-half program entitled Translational Medicine in Oncology: Bridging the Gap Between Basic Science and the Clinic. The program will be at the Hilton Garden Inn at the Albany Medical Center on Thursday-Friday, September 27th & 28th. CME credits are available. You can download the invitation HERE. (If you have trouble downloading the pdf file, please call the Medical Society at 518-456-8571 and we will fax you a copy.)

posted at 3:25 P.M. by Jonathan H. Dougherty, M.S.

Thursday, September 6, 2007

HERE is a pretty neat poster brought to my attention by Nancy Adams of MONROE COUNTY MEDICAL SOCIETY. It's an AMA poster advertising a physician's dedication to quality in light of proprietary managed care's attempt to rate physicians based on cost. Every office should be hanging this poster!

posted at 12:00 P.M. by Jonathan H. Dougherty, M.S.

Wednesday, September 5, 2007

Here is an interesting article sent to me by my colleague Nancy Adams in Monroe County:

Federal Court Orders Government to Pay Doctor's Legal Fees for Frivolous Prosecution

Reprinted from the August 27, 2007, issue of REPORT ON MEDICARE COMPLIANCE, the nation's leading source of news and strategic information on false claims, overpayments, compliance programs, billing errors and other Medicare compliance issues.

A federal judge in Nevada has ordered the government to pay a physician about $280,000 in legal fees after a failed health fraud prosecution, calling some of it "frivolous." The physician won a motion using the Hyde Amendment, a tool to hold prosecutors accountable if a federal judge agrees they acted in less-than-good faith. It's extremely rare for the government to be forced to shell out court costs to former criminal defendants, a former federal prosecutor says. The U.S. Attorney's Office for the District of Nevada said it would appeal.

Mark Capener, M.D., an ear, nose and throat specialist, was charged in July 2005 with 38 counts of health care fraud, 13 counts of mail fraud, and one count of making a false statement to the FBI. The U.S. attorney's office alleged that Capener billed Medicare and other payers for unnecessary surgery, billed for services not rendered, and upcoded, according to the indictment. For example, the indictment alleged that Capener billed payers for CPT 31276 (nasal/sinus endoscopy, surgical with frontal sinus exploration, with or without removal of tissue from frontal sinus) when there was no indication that the surgery was needed, and often without adequate time to perform it or documentation to support it.

The physician was acquitted last year.

Capener then filed a motion under the Hyde Amendment. U.S. District Judge Robert C. Jones recently ordered the government to pay Capener $175,006 in court costs and $104,009 in attorneys' fees. Former federal prosecutor Gil Soffer was very surprised that Capener prevailed with the Hyde Amendment. "Generally, it takes a great deal before the court will say, especially in criminal cases, that the government has acted frivolously. After all, the government doesn't get an indictment until after presenting the case to a grand jury," says Soffer, a Chicago lawyer who was not involved in the Capener case. "When you have an indictment, it reflects probable cause that the defendant committed the crime, so you rarely find a truly frivolous indictment. But here the judge is saying part of this case had no backing in evidence and was patently untrue," says Soffer, who is with the law firm of Katten Muchin Rosenman LLP.

Jones is the judge who was highly critical of a prosecution of another physician by the U.S. Attorney's Office for the District of Nevada about a year ago.

Pathologist Undercut Expert Witness

In attempting to prove its case, the government "relied heavily" on an expert witness, physician Dale Rice, M.D., who is also an ear, nose and throat specialist, according to Jones' decision. Rice testified that Capener didn't perform surgeries that he billed for and performed unnecessary procedures.

Rice premised his testimony — and the government therefore based its case — on "four pillars," the court decision said: (1) There were no bone fragments in Capener's patients' pathology reports, and Rice said that meant Capener didn't perform many of the nasal surgeries that he said he did; (2) Capener's procedures couldn't have been performed in the time span he reported; (3) CT scans on some patients showed an absence of surgery; and (4) CT scans confirmed Capener "billed for procedures beyond those he actually performed."

Before Capener went to trial, the indictment charged him with 52 counts. And then, "during the course of trial, it became evident the Government could not sustain indictments based on some of their 'pillars,'" Jones said, so the court dismissed additional counts. By the time the jury started deliberating, 25 counts were left. In November 2006, the jury returned a not-guilty verdict.

But the intrigue did not end there. Capener filed a motion to recover fees and costs from the government under the Hyde Amendment. The physician "claims the government based its case on deliberately false testimony," the court decision explains.

Congress enacted the Hyde Amendment so there would be recourse to penalize prosecutorial misconduct, the judge explained. Courts can award litigation fees to a "prevailing party" if "the court finds that the position of the United States was vexatious, frivolous or in bad faith."

The definition of a frivolous case is one that's "groundless.with little prospect of success; often brought to embarrass or annoy the defendant," the judge wrote, citing United States v. Braunstein. To prove frivolousness, Capener had to show the prosecution had reason to believe its case lacked support. Capener noted that before trial, the government interviewed the pathologist who did pathology reports on Capener's patients, the court decision states. "At trial, [the pathologist] testified that contrary to the Government's assertion, bone fragments existed in all the pathology slides, and that he would have so told anyone who asked him before trial. The evidence confirmed that Capener's pathology slides contained bone fragments. This showing completely destroyed one of the Government's main arguments in support of its case," the judge wrote. "Either the Government consciously decided to proffer a theory it knew was false, or it failed to conduct any investigation or inquiry to confirm whether Dr. Rice's contentions regarding lack of bone fragments was in fact accurate. In addition, the Government failed to produce to Capener expert disclosures from Dr. Rice, which discussed the lack of bone as a basis for his opinions. Taken together, these facts indicate the Government had reason to believe their lack-of-bone theory was without support."

As a result, the court declared that the government "pursued frivolous claims as to the fraud-related counts based on the Government's first pillar - the lack of bone in the pathology reports from surgery."

However, the court disagreed with Capener that the prosecution had acted vexatiously or in bad faith. But in granting his motion in part, the court awarded Capener the significant fees.

Capener's lawyer did not return RMC's phone calls. The U.S. attorney's office would not comment because of the pending appeal.

The court decision is U.S. vs. Mark Capener (3:05-CR-0114-RCJ-RAM).

posted at 1:20 P.M. by Jonathan H. Dougherty, M.S.