St. Louis-area prac­tices adopt med­i­cal home model, and other news

Modern Healthcare - - NEWS -

ST. LOUIS—

Five area pri­mary-care prac­tices are par­tic­i­pat­ing in a pi­lot project to im­prove care by adopt­ing the pa­tient-cen­tered med­i­cal home model. The five prac­tices are mem­bers of the St. An­thony’s Physi­cian Or­ga­ni­za­tion, which is af­fil­i­ated with 602-bed St. An­thony’s Med­i­cal Cen­ter in St. Louis. They will re­ceive fund­ing for a nurse to act as a care man­ager. Other per­son­nel, such as a di­a­betes ed­u­ca­tor, will be avail­able as well, and pa­tients will have ac­cess to a se­cure on­line por­tal for com­mu­ni­ca­tion with the prac­tices, ac­cord­ing to an e-mailed news re­lease. The Mis­souri Foun­da­tion for Health Phi­lan­thropy has pro­vided around $575,000 to CSI So­lu­tions, Bethesda, Md., for the ad­min­is­tra­tion of 18-month learn­ing col­lab­o­ra­tives that of­fer in­for­ma­tion on trans­form­ing prac­tices into med­i­cal homes. The prac­tices are staffed by 18 doc­tors, two physi­cian as­sis­tants and two nurse prac­ti­tion­ers. “The pri­mary-care spe­cialty be­comes all- en­com­pass­ing, as the physi­cian looks to treat the phys­i­cal, emo­tional, men­tal, psy­cho­log­i­cal, so­ci­o­log­i­cal, eco­nomic and spir­i­tual needs of the pa­tient,” said prac­tice ad­min­is­tra­tor Ron Fin­nan in the re­lease. “Can the physi­cian, alone, pro­vide all of this? Ab­so­lutely not. But the physi­cian can be the quar­ter­back for the rest of the health­care team. It’s a part­ner­ship among physi­cian, care man­ager, staff, pa­tient and fam­ily.” ROSE­MONT, Ill.—

Life­watch Ser­vices reached an $18.5 mil­lion set­tle­ment with the gov­ern­ment over al­le­ga­tions that the am­bu­la­tory health mon­i­tor­ing com­pany filed false Medi­care claims, the U.S. Jus­tice Depart­ment an­nounced. The com­pany did not ad­mit li­a­bil­ity or wrong­do­ing in the set­tle­ment, which re­solves two law­suits filed un­der the whis­tle-blower pro­vi­sions of the False Claims Act. Both com­plaints say Life­watch filed fraud­u­lent claims to Medi­care for am­bu­la­tory car­diac teleme­try ser­vices. Life­watch al­legedly knew those ser­vices weren’t el­i­gi­ble for Medi­care re­im­burse­ments for pa­tients with mild or mod­er­ate heart pal­pi­ta­tions. The com­pany used a false di­ag­nos­tic code to have claims paid and also made claims for ser­vices in the form of full­time em­ploy­ees to sev­eral hos­pi­tals and med­i­cal prac­tices with­out charge, ar­range­ments that amounted to kick­backs, ac­cord­ing to the Jus­tice Depart­ment. “The chief ex­ec­u­tive of­fi­cer at Life­watch as well as other cor­po­rate ex­ec­u­tives will be re­quired to per­son­ally cer­tify com­pli­ance with our five-year (cor­po­rate in­tegrity agree­ment), which in­cludes pro­vi­sions to mon­i­tor Life­watch’s claim sub­mis­sion process, sales force ac­tiv­i­ties and re­la­tion­ships with some types of busi­ness re­fer­rals,” HHS In­spec­tor Gen­eral Daniel Levin­son said in a pre­pared state­ment. Two for­mer Life­watch sales rep­re­sen­ta­tives filed the suits: One in 2009 in Washington, D.C., and an­other in 2011 in Ohio. To­gether they will re­ceive $3.4 mil­lion with in­ter­est as their share of the set­tle­ment, ac­cord­ing to the news re­lease.

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