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Doctors & Hospitals

Jul 28 2014 : The Times of India (Chennai)
US hospitals are fined millions for unethical acts, Indian ones go free

Crackdown On Cuts To Docs, Unnecessary Procedures

Even as no action has been taken by the Indian government on hospitals giving doctors a cut for referring patients and for carrying out unnecessary procedures, in the US, six hospitals have been fined several million dollars since the beginning of the year for exactly such practices.

In the face of hard evidence of doctors getting commissions, health minister Dr Harsh Vardhan recently promised he would refer the matter to the ethics committee of the Medical Council of India -ironically, a body he had himself referred to as “a big source of corruption“.

In contrast, there has been a sys tematic crackdown in the US on healthcare fraud through the Health Care Fraud Prevention and Enforcement Action Team (HEAT) initiative, which was constituted in May 2009 by the attorney general's office and the health and human services department.

In July, the Infirmary Health system in Alabama had to pay $25 million to resolve allegations that its clinics routinely overpaid doctors to refer their radiology patients to its hospitals. In May, the US justice department reached a tentative settlement of a whopping $85 million dollars with Halifax Health in Florida for allegedly paying illegal “productivity bonuses“ to doctors who ordered unnecessary nuclear imaging tests on patients.

In the same month, a hospital in Kentucky had to pay nearly $41 million to resolve allegations of making money on unnecessary coronary stents and diagnostics catheterizations and also for having improper financial relationships with physicians referring patients to the hospital. Post of these cases have been filed under the Stark Law, a law meant to limit the influence of money on medical decision-making on the part of physicians by prohibiting financial relationships between hospitals and referring physicians.

Some specific exceptions have been allowed.

Many of these cases were also filed under the False Claims Act, a Civil War-era law that makes it a civil violation to overbill government programs.

The law allows a tripling of damages if the conduct is found to be intentional or arising from reckless disregard for the law. ] Many of these settlements have hit the offending hospitals hard. For instance in Ohio, a 71-bed hospital had to pay a settlement of $8.5 million, when its total revenue that year was $72 million.



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