News in brief - Sept. 15, 2003

Medicare makes changes to EMTALA - CMS provides online automated edits - Calif. physician pleads guilty to Medicare fraud

Medicare makes changes to EMTALA

The Centers for Medicare & Medicaid Services issued a final rule implementing changes designed to make the Emergency Medical Treatment and Active Labor Act more workable for doctors and hospitals.

The rule, which will become effective Nov. 10, clarifies circumstances under which physicians must serve on emergency department on-call lists. Hospitals will be able to develop the call lists in ways that best meet the needs of their communities, CMS said. Doctors can be on call simultaneously at multiple hospitals and will be permitted to schedule elective surgery or other procedures while on call.

CMS provides online automated edits

Physicians now can see what "edits" Medicare contractors use to identify questionable claims. The Centers for Medicare & Medicaid Services has posted edits used to identify pairs of services that normally should not be billed by the same physician for the same patient on the same day.

Previously, the edits had been available on a paid subscription basis. CMS said providing the edits free of charge was the latest step in its strategy to use the Internet to reduce physicians' regulatory burden. The edits are posted online cms.hhs.gov/physicians/cciedits/.

Earlier, CMS added a feature to its Web site allowing physicians to look up what they will be paid for a particular service or range of services. That feature is also online cms.hhs.gov/physicians/mpfsapp/.

Calif. physician pleads guilty to Medicare fraud

A Los Angeles physician in August pleaded guilty to five counts of health care fraud in connection to bills sent to Medicare between January 2000 and May 2002 for services that were never performed or were performed, but weren't medically necessary, according to U.S. Attorney Debra W. Yang in the Central District of California. Federal officials say the billing resulted in a $3.2 million loss.

The government said Lakshmi Nadgir, MD, 57, ran a medical clinic in Los Angeles and paid her office staff to bring in patients with Medicare beneficiary cards for "treatment" that wasn't needed or so that their Medicare numbers could be used for services that weren't performed. Dr. Nadgir is scheduled to be sentenced Nov. 3 and faces up to 50 years in federal prison.