Mutual Matters

Communication Breakdown Contributes to Shoulder Dystocia Claim

Posted by Marshaleen King, MD on Dec 14, 2017 2:24:58 PM

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Topics: Patient Care and Interaction

Don’t Complicate your Complication, a surgical complication case study

Posted by Marshaleen King, MD on Nov 30, 2017 1:00:00 PM

Case Scenario

A 64-year-old woman presented to the emergency room (ER) with right sided abdominal pain. Her ER evaluation revealed cholelithiasis with thickening of the gall bladder wall. The patient was admitted by the surgical team on call and underwent laparoscopic cholecystectomy. 

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Topics: Patient Care and Interaction

Reducing Medical Errors by Improving the Diagnostic Process

Posted by Marshaleen King, MD on Nov 16, 2017 1:30:00 PM


Medical errors remain a major cause of morbidity and mortality and recent estimates indicate that it is likely the third leading cause of death in the US, [1] with some sources reporting an incidence of 210,000 to 400,000 deaths annually due to errors among hospitalized patients.[2]

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Topics: Patient Care and Interaction

Billing Under Another Provider's Number Can Land Physicians in Hot Water

Posted by Emma Cecil on Nov 7, 2017 11:29:00 AM

An Oklahoma physician agreed on August 28, 2017 to pay the government $580,000 to resolve allegations that he violated the False Claims Act by submitting claims to the Medicare program for services he did not provide or supervise. According to the government, the physician allowed a company that employed him and in which he had an ownership interest, to use his national provider identification (NPI) numbers to bill Medicare for physical therapy evaluation and management services that he did not provide or supervise. The government further alleged that after he separated from the company and deactivated his NPIs associated with the company, he reactivated those NPIs so that the company could use them to bill Medicare for services he neither performed nor supervised.

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Topics: Billing and Reimbursement

Lack of Medical Necessity & the Criminalization of Clinical Decision Making

Posted by Emma Cecil on Oct 31, 2017 11:00:00 AM

In 2010, Georgia nursing home owner and operator, George Houser, was charged in a federal indictment with conspiracy to commit healthcare fraud on the theory that he had billed Medicare and Medicaid for services that were so inadequate or deficient that they were essentially “worthless.”

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New GA Controlled Substances CME Requirement – Effective Jan. 1, 2018

Posted by Carrie Lowe, J.D. on Oct 19, 2017 1:00:00 PM

Georgia physicians who have an active DEA certificate and prescribe controlled substances are now required to complete, one time, three hours of CME that are designed to specifically address controlled substance prescribing, including:

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Hospital Pays $42 Million to Resolve False Claims Act Allegations

Posted by Emma Cecil on Oct 12, 2017 1:00:00 PM

Los Angeles-based acute care hospital, Pacific Alliance Medical Center (PAMC), has agreed to pay $42 million to resolve whistleblower allegations that it violated the False Claims Act (“FCA”) by submitting, or causing to be submitted, false claims to Medicare and MediCal for services rendered to patients who had been referred by physicians with whom PAMC had improper financial relationships.

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Costly Genes: Genetic Testing and Patient Care

Posted by Marshaleen King, MD on Oct 5, 2017 12:23:00 PM

Case scenario

A 28-year-old woman presented to a primary care physician for a new patient visit. The physician conducted a fairly thorough history; however, he obtained the patient’s family history from a patient intake form, which only included questions about hypertension, heart disease and diabetes in family members. The physician neglected to ask the patient about any family history of cancer and failed to revisit her family history at any point during her subsequent follow-up visits.   

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Case Study: Wrong Site Surgery

Posted by Hall B. Whitworth, Jr., MD on Oct 3, 2017 12:08:00 PM

A 49-year-old man underwent a colonoscopy by a colorectal surgeon who identified a large, firm tumor causing partial narrowing, approximately 60-70 cm from the entry site. Pathology of this tumor was suspicious for carcinoma. In addition, a polypectomy was performed at a different location, and the site was tattooed. Pathology of this second site was consistent with tubulovillous adenoma.

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OIG Estimates Medicare Paid Over $700 Million in Noncompliant EHR Incentive Payments

Posted by Scott R. Grubman, Esq. on Sep 26, 2017 1:00:00 PM

Scott R. Grubman, Esq. Gregory A. Tanner, Esq. Chilivis, Cochran, Larkins & Bever, LLP

On June 7, 2017, the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services (HHS) released a report estimating that Medicare paid over $729 million in improper EHR incentive payments to healthcare providers who did not meet meaningful use requirements. 

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Sharing Insight on Mutual Matters

Here we share some basic insights on matters that are important to physicians, hospitals and healthcare professionals.

Topics include:

  • Legislative updates that affect healthcare professionals
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