News in brief - Sept. 19, 2005

AMA chief lobbyist to retire - Power wheelchair rule issued - California accuses 39 drug companies of defrauding Medi-Cal - Ohio attorney general launches Web site for Medicaid fraud reporting

AMA chief lobbyist to retire

Lee J. Stillwell, senior vice president of the American Medical Association's advocacy group, will retire Oct. 1, the Association recently announced.

Stillwell, who joined the AMA in 1987, will stay on as a consultant and will assist in a nationwide search for a permanent replacement for the Association's top lobbyist in Washington, D.C. AMA Executive Vice President and CEO Michael D. Maves, MD, MBA, will assume responsibility for the advocacy group in the meantime.

"The political landscape has been challenging in recent years, but Lee and his team continued to move the needle positively on the issues that mattered to physicians and their patients, including a hard-fought victory on patient safety earlier this year," Dr. Maves said in a statement. AMA lobbying efforts in Washington will not slow down because of Stillwell's departure, he said.

Power wheelchair rule issued

Physicians prescribing power wheelchairs or scooters to Medicare beneficiaries after Oct. 25 must provide new documentation from the patients' medical records for the government to approve claims.

The Centers for Medicare & Medicaid Services in late August issued an interim final rule that describes the additional clinical information that needs to accompany any power-operated vehicle claim. Recognizing that the new mandate will require more paperwork for physicians and other practitioners, CMS is authorizing a new billing code for an additional administrative payment for the claims.

CMS earlier this year released a national coverage determination outlining a new set of guidelines that doctors must use in assessing whether patients need the devices.

The latest regulation, which also removes a requirement that prescribing physicians be part of certain select specialties, is available online (www.cms.hhs.gov/coverage/wheelchairs.asp).

California accuses 39 drug companies of defrauding Medi-Cal

California Attorney General Bill Lockyer sued 39 drug companies in August, accusing the pharmaceutical manufacturers of defrauding Medi-Cal, the state's Medicaid program.

The lawsuit, filed in U.S. District Court in Boston, alleges the companies manipulated drug prices, which caused the Medi-Cal program to pay inflated rates and bilked California taxpayers out of potentially hundreds of millions of dollars. The lawsuit also alleges the companies provided false, inflated drug pricing data knowing that the state relied on that information to set reimbursement rates.

"This scheme ... is jeopardizing the public health by diverting money away from patient care," Lockyer said in a statement. "The amount of money that drug companies have cheated out of California could have been better spent on ensuring that every child in this state has access to health care."

The lawsuit amends a complaint California filed against two drug companies two years ago by adding about three dozen more companies.

Ohio attorney general launches Web site for Medicaid fraud reporting

Ohio residents have a new Web site they can visit to report Medicaid fraud, patient abuse and patient neglect.

The site (www.ag.state.oh.us/sections/health_care_fraud/report.asp), launched in August, adds another reporting option for citizens, who previously could call an abuse hotline, write letters or send e-mail to Attorney General Jim Petro's office.

While the Ohio State Medical Assn. has a zero-tolerance policy for anyone who would knowingly commit Medicaid fraud, a Web site allowing patients easily to file a complaint could result in false accusations, said Tim Maglione, the association's government relations director.

Patients may believe a physician is committing fraud when, actually, the doctor is simply dealing with the billing system's complexities, Maglione said.

"We need to strike the appropriate balance between those who may be intentionally committing fraud versus those who have a difference of opinion on how to code something," he said.

Maglione said OSMA would monitor the development to ensure physicians are not being unduly burdened by false accusations.