CMS indicates that it is again considering compensating physicians for discussions and advice with patients concerning end of life decisions. The American Medical Association requested consideration of the issue last fall.
In July, 2012, Rosemary N, Collyer, a United States District Court Judge for the District of Columbia, ruled that autologous stem cells re-injected into a person’ body following a acculturation of the cells with the use of another drug product shipped in interstate commerce is a “drug” subject to regulation by the U.S, Food and Drug Administration. The purpose of the re-injection is to stimulate the regrowth of bone, cartilage and other human tissue to regenerate them in lieu of joint transplants and other orthopedic surgical procedures.
The Institute of Medicine and the National Research Counsel announced the pre-publication release of their report on their recent comparison of health care data between the U.S. and 16 other countries which crosses all age categories. The other countries include Canada, Japan, Australia, Germany, Austria, Denmark, Finland, Norway, Portugal, Sweden, Switzerland, the Netherlands, the United Kingdom and Spain. This is a fascinating read entitled U.S. Health in International Perspective: Shorter Lives, Poorer Health is currently available to read on line for free at the National Academies Press website. The U.S. generally finished near the bottom in most categories for the population under the age of 75. Our post 75 population, outscores their peers elsewhere.
The First U.S. Circuit Court of Appeals has upheld a $ 2 Million Dollar Jury Verdict in favor of a San Juan Puerto Rico Cardiologist who claimed he had been retaliated against for filing an age discrimination case five years earlier. In actual fact, the plaintiff Dr. Munoz was fired within days of giving a deposition in the case wherein he recounted his evidence. The defendants appealed on the basis that the decision to fire him had been made well before his deposition and could not be the basis for establishing a retaliation claim under the Age Discrimination Act of 1967 (ADEA), 29 U.S.C. Section 623 d. The Court agreed, to a point, but found that the retaliation could relate back to the original filing, given other facts.
Yesterday, a panel of the federal 9th Circuit Court of Appeals considered a challenge to the constitutionality of the National Organ Transplant Act (the “Act”) as it relates to restricting compensation to bone marrow cell donors whose cells are extracted through apherisis. The Act prohibits the compensation of donors of body organs including specifically, bone marrow, but permits compensation for blood, sperm, and eggs. In Flynn et al v. Eric Holder, No. 10-55643 (9th Cir. 2011), the Plaintiffs, who included a variety of persons and entities adversely affected by the difficulty of obtaining donations of bone marrow, argued that there was no rational basis for distinguishing between the donation of blood plasma and the donation of hematopoietic stem cells which are excreted from the bone marrow itself into the blood stream in thus implicating the “equal protection clause” of the Constitution.
It was to say the least startling to watch the Utube video of Rep. Michele Bachmann holding forth in another otherworldly tirade against “Obamacare” in Webster City, Iowa. It was even more scary to see the audience sitting their calmly, politely and acceptingly as if “chewing the cud” while her fantasies poured fourth. This is no joke. She told her audience that a seven foot plus doctor told her that he waited on the phone for 2 hours and 15 minutes with the IRS awaiting for approvals of care for “a little lady in my office,” while patients stacked up in his waiting room.
According to a GAO report in 2005 approximately seventy five percent of those physicians providing concierge medicine services do not opt out of Medicare, but provide some services either as a participating or non-participating physician. Those physicians must be very careful to assure that they do not charge concierge customers for any service that might be otherwise covered by Medicare which can create a potential claim for over-billing for medicare services in violation of the False Claims Act.
There is a fair amount of confusion afoot concerning the obligation or not of physicians to accept Medicare patients. There is no requirement that any physician accept Medicare patients or refrain from limiting the number of Medicare patients accepted into the physician’s practice. There are circumstances when it may be in the best interest of a physician to “opt out” of Medicare. The growth of concierge medicine in some respects makes it safer for physicians to “opt out” of Medicare in order to avoid stepping afoul of the Medicare fee limitations by charging for services that might be construed by CMS or the OIG as being extra contractual charges which might implicate the federal false claim statute. According to 2005, General Accounting Office Survey of providers of concierge medicine, only about 25% of them had opted out and were practicing on the cash only high wire without the Medicare safety net.
Dr. Richard R. Lopez, Jr., the former head of the liver transplant program at St. Vincent Medical Center in Los Angeles, received a jury verdict of acquittal against federal charges that he was engaged in a conspiracy to coverup the jump switch of an available liver over 50 patients waiting in line to a wealth Saudi. Mr. Saud Al-Harthi, the patient who was next in line for the liver was told to go home to await word on availability. He died waiting for the call that never came.
In Murray v. UNMC Physicians, Neb.. No. S-10-455, (9/16/11), the Plaintiff’s wife, Ann Murray suffered from pulmonary arterial hypertension, a chornic constriction of the blood vessels in the lungs which pressures the heart, ultimately leading to death. Flolan (epoprostenol sodium), is a very expensive drug that is effective in the direct vasodilation of pulmonary and systemic arterial vascular vessels.