And just were these now-newly-charged defendants thinking?

 The Secretary of the DHHS and the US Attorney General just announced that 107 physicians and others have been charged in a Medicare scam, “breathtaking in scope.”  The allegations are that these 107 doctors, nurses, and others have defrauded the government of up to $452 million in Medicare payments.  The illegal activities occurred in Chicago, Houston, Los Angeles, Detroit, Tampa, and Baton Rouge, Louisiana.  Reports are that in the latter city alone seven individuals from two community health centers have been charged with submitting false claims of $225 million.

 What is sad is that the services of community mental health services are needed, and criminal activities such as these place ALL of these centers, and others, under the spotlight in a manner that can affect the delivery of care.  But the fraud appears so vast, and the amounts of money so great, that one cannot help but understand why there needs to be a laser-like focus on fraud and abuse and compliance.  I hope that as time goes on and the government’s efforts at fighting fraud start bearing real fruit in the form of reduced fraud (and consequent reduced governmental expenditures) that the good guys rise to the top.

 Oh, and the answer to the question above?   To paraphrase Willie Sutton, Medicare is where the money is – a lot of it.

Hold on to your hats, because New Hampshire could enact one of the toughest “anti-self-referral” statutes in the US.  If HB 1725 passes and you are a New Hampshire physician (a) who may profit, indirectly or directly, from the sale of an FDA class II or class II medical device or (b) who may perform a procedure involving the device, you could be charged with (1) an unfair or deceptive act or practice in violation of NH Consumer Protection statute, and (2) a fine of $5000 for a first offense and loss of your license for a second offense.  Ouch!

In addition, HB 1725 as passed by the NH House in March specifically disallows any claims for payment for “any medical device provided” in violation of this proposed law.

So, what’s going on?  Is there a problem with physician owned distributors in New Hampshire?  I am not aware of any.   At the same time, there are certainly physicians who have been active in creating and inventing particular devices in association with academic medical centers or medical device manufacturing firms to make newer and improved devices.  Is this a “problem” that the State feels is necessary to correct at the moment?  Or does the NH House think the laws should be “clarified” prior to an “onslaught” of distributors.

We already have a law in place that requires a physician to disclose to patients the physician’s ownership interest in any health care facility that the physician may refer patients.  It seems to work well because it does not impede care.  It seems to me that this could be extended to devices, as well.  HB 1725, on the other hand, directly impedes care in those circumstances where a physician has a monetary interest in the device.  Certainly, it is a good idea for full disclosure of some sort of interest to be made, but HB 1725, as presently written, does not allow the physician to even consider the use of a device that the physician herself may have a monetary interest in, or may wish to employ to help a patient.

My sense is that a “bad story” came to certain legislators’ attention.  We will see on April 19 how the NH Senate addresses the bill.