Wednesday, February 3, 2010

Hospital Whistleblower Lawsuit: Where The Drumbeat of "Defensive Medicine" Meets The Cowbell Of Fraud...

Those arguing for medical lawsuit "reforms" repeat over and over that doctors and hospitals are forced to practice "defensive medicine" because of a fear of lawsuits, which drives up the cost of healthcare, etc. What is often ignored by the medical and insurance groups pushing this argument is that some doctors and hospitals stand to gain financially from the very tests and procedures they love to label as "defensive medicine."

Recently, a Cincinnati hopsital agreed to settle a whistleblower lawsuit brought by a cardiologist and the federal government alleging a fraudulent "kickback scheme" where cardiologists' access to the hospital for heart procedures was allegedly based upon the revenue they generated for the hospital. And while Christ Hospital denied any sort of wrongdoing, it agreed to a whopping $100 million settlement with the government in order to reimburse Medicare.

You can draw your own conclusions from the fact of the settlement and, more importantly, the amount of it. These allegations, if true, show how a hospital's business model impacts patient care (more tests being run on patients), the hospital's bottom line, AND the cost of healthcare. After all, if hospitals are billing Medicare for more tests as part of some suspect billing or kickback scheme, what is that doing to our Medicare funds? (Depleting them is the right answer...).

Yet, this $100 million head turner of a settlement at one hospital will not get much attention from the politicos. They're too busy dragging out and continuing to beat the "trial lawyers are causing doctors and hospitals to practice defensive medicine" drum at every opportunity.

This piece of news is more like a small cowbell instead of a drum. And as we all know from the now famous Will Farrell Saturday Night Live skit, we all need "More Cowbell."

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