News in brief - Oct. 23/30, 2000

Lawmakers try one last push for patient protection legislation - Pathology lab settles lawsuit charging fraudulent Medicare billing - Hospital chain settles whistle-blower lawsuit on Medicare cost reports

Lawmakers try one last push for patient protection legislation

Reps. Charles Norwood, DDS (R, Ga.), and Greg Ganske, MD (R, Iowa), unveiled in early October a new version of their managed care patient protection bill that they say has the support of a majority of the House as well as the Senate. Compromises in the new Norwood bill won over Sen. John Ashcroft (R, Mo.), thus tipping the vote count to a majority.

The measure's chances of passage, however, were unclear at press time. Support fell short of the vote needed to block a threatened filibuster by Senate Republicans. Meanwhile, an aide to Sen. Edward Kennedy (D, Mass.) said Democrats had not lined up behind the new bill because they thought the Republican leadership would block it, so they preferred to back the previous version.

The latest model of the bill would split consideration of patients' lawsuits between the state and federal courts. State courts would consider cases involving health plans' medical decision-making. The federal courts would consider cases aimed at determining whether the benefit in question was included in the plan or whether a patient was enrolled. The measure also would cap damages in federal court at $5 million and would allow states to petition the federal government to waive its standards in favor of similar state rules.

Pathology lab settles lawsuit charging fraudulent Medicare billing

APL Health Care Group, a medical testing and pathology lab in Las Vegas, agreed in October to pay the federal government $1.5 million to settle a Medicare fraud case.

The whistle-blower suit charged that between 1989 and 1993, APL billed Medicare for blood tests that doctors did not need for their patients and for tests that weren't specifically ordered. Doctors were unaware that APL billed Medicare separately for them. APL did not admit any wrongdoing by settling the charges.

Hospital chain settles whistle-blower lawsuit on Medicare cost reports

Quorum Health Group Inc., which operates hospitals through affiliates nationwide, agreed in October to pay $95.5 million to the federal government to settle two whistle-blower lawsuits involving Medicare fraud.

Company executives agreed to pay $77.5 million to settle charges that the firm had filed fraudulent Medicare cost reports for years. The other $18 million settles a lawsuit that accused Quorum of misallocating costs from an Alabama hospital to a home health services agency.