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Self-insured companies going after doctors to recover

When Snellville, Ga., internist Joel Fine, MD, read a note from a company called Health Research Insights, he thought it sounded a little bit like a chain letter -- vaguely threatening, insistent on a quick response, with few details. The letter, addressed "Dear Health Care Professional," accused Dr. Fine of upcoding four claims for treating Georgia-Pacific employees. The earliest dated back to February 2005. "Of course, I was offended," Dr. Fine said. HRI's letter offered him two choices: pay $347 to "immediately settle this issue" or send complete records proving he did not incorrectly bill for the visits in question. The letter warned that if Dr. Fine did not pay HRI or contact them with records to prove his innocence, his case could be turned over to federal authorities. "The intimidation is really strong here," he said. "They are working under the guilty-until-proven-innocent philosophy." HRI, which sent Dr. Fine the letter in February, works on behalf of large compani ...

1 in 5 Medicare patients readmitted within a month after hospital release

Nearly 20% of Medicare patients discharged from hospitals were readmitted within 30 days, costing taxpayers $17.4 billion, according to an April 2 study in the New England Journal of Medicine. About 10% of rehospitalizations were planned to continue needed care, the study found. But as many as 40% of them -- or about 1 million readmissions -- were preventable, said Stephen F. Jencks, MD, MPH, lead author of the study ( "It is very clear that high rehospitalization rates are not ordained," Dr. Jencks said at a news conference. "When it is preventable, rehospitalization is a terrible waste of money, and many are preventable." Dr. Jencks and his co-authors analyzed Centers for Medicare & Medicaid Services claims data on hospital discharges of Medicare patients in 2003 and 2004. The rates varied widely among states and individual hospitals. The top five states -- Louisiana, Illinois, West Virginia, Kentucky and Mississippi -- had ...

Pharma support of medical societies raises conflict-of-interest concerns

The American Psychiatric Assn. in March said that to erase the risk of bias, it will phase out the $1.5 million in drugmaker money it uses to fund continuing medical education. The same month, the American College of Cardiology declined to distribute nearly half a million dollars in industry-funded, logo-branded tote bags, lanyards and badges at its annual scientific session. The moves reflect physician organizations' growing sensitivity about potential conflicts of interest. And if an expert panel has its way, the actions will mark the start of a shift toward reducing medical societies' reliance on financial support from pharmaceutical companies, drugmakers and industry firms. In an April 1 report in the Journal of the American Medical Association, a group of 11 researchers and doctors -- many with experience as medical society leaders -- said physician organizations should strive for zero dollars in industry funding of their activities. In the short term, the group said, any me ...