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Published in: Clinical Orthopaedics and Related Research® 8/2014

01-08-2014 | Not the Last Word

Defending Waste, Fraud, and Abuse

Author: Joseph Bernstein, MD

Published in: Clinical Orthopaedics and Related Research® | Issue 8/2014

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Excerpt

Medicine may be a noble profession, but its members do not always act nobly. In Maryland, a cardiologist was convicted for “documenting” coronary artery disease that did not exist, inserting stents into vessels that did not need them, and submitting fraudulent medical bills for that effort [15]. In New York, an orthopaedic surgeon was sentenced to 8 years in prison for using his medical practice as a disability mill [16]. …
Literature
1.
go back to reference Chan PS, Patel MR, Klein LW, Krone RJ, Dehmer GJ, Kennedy K, Nallamothu BK, Weaver WD, Masoudi FA, Rumsfeld JS, Brindis RG, Spertus JA. Appropriateness of percutaneous coronary intervention. JAMA. 2011;306:53–61.PubMed Chan PS, Patel MR, Klein LW, Krone RJ, Dehmer GJ, Kennedy K, Nallamothu BK, Weaver WD, Masoudi FA, Rumsfeld JS, Brindis RG, Spertus JA. Appropriateness of percutaneous coronary intervention. JAMA. 2011;306:53–61.PubMed
2.
go back to reference Cobos R, Latorre A, Aizpuru F, Guenaga JI, Sarasqueta C, Escobar A, García L, Herrera-Espiñeira C. Variability of indication criteria in knee and hip replacement: an observational study. BMC Musculoskelet Disord. 2010;11:249.PubMedCentralPubMedCrossRef Cobos R, Latorre A, Aizpuru F, Guenaga JI, Sarasqueta C, Escobar A, García L, Herrera-Espiñeira C. Variability of indication criteria in knee and hip replacement: an observational study. BMC Musculoskelet Disord. 2010;11:249.PubMedCentralPubMedCrossRef
3.
go back to reference Cram P, House JA, Messenger JC, Piana RN, Horwitz PA, Spertus JA. Indications for percutaneous coronary interventions performed in US hospitals: a report from the NCDR((R)). Am Heart J. 2012;163:214–221 e1. Cram P, House JA, Messenger JC, Piana RN, Horwitz PA, Spertus JA. Indications for percutaneous coronary interventions performed in US hospitals: a report from the NCDR((R)). Am Heart J. 2012;163:214–221 e1.
6.
go back to reference Dieppe P. Lim K, Lohmander S. Who should have knee joint replacement surgery for osteoarthritis? Int J Rheum Dis. 2011;14:175–180.PubMedCrossRef Dieppe P. Lim K, Lohmander S. Who should have knee joint replacement surgery for osteoarthritis? Int J Rheum Dis. 2011;14:175–180.PubMedCrossRef
7.
go back to reference Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Blaha MJ, Dai S, Ford ES, Fox CS, Franco S, Fullerton HJ, Gillespie C, Hailpern SM, Heit JA, Howard VJ, Huffman MD, Judd SE, Kissela BM, Kittner SJ, Lackland DT, Lichtman JH, Lisabeth LD, Mackey RH, Magid DJ, Marcus GM, Marelli A, Matchar DB, McGuire DK, Mohler ER 3rd, Moy CS, Mussolino ME, Neumar RW, Nichol G, Pandey DK, Paynter NP, Reeves MJ, Sorlie PD, Stein J, Towfighi A, Turan TN, Virani SS,Wong ND, Woo D, Turner MB; American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics–2014 update: a report from the American Heart Association. Circulation. 2014;129:e28–e292.PubMedCrossRef Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Blaha MJ, Dai S, Ford ES, Fox CS, Franco S, Fullerton HJ, Gillespie C, Hailpern SM, Heit JA, Howard VJ, Huffman MD, Judd SE, Kissela BM, Kittner SJ, Lackland DT, Lichtman JH, Lisabeth LD, Mackey RH, Magid DJ, Marcus GM, Marelli A, Matchar DB, McGuire DK, Mohler ER 3rd, Moy CS, Mussolino ME, Neumar RW, Nichol G, Pandey DK, Paynter NP, Reeves MJ, Sorlie PD, Stein J, Towfighi A, Turan TN, Virani SS,Wong ND, Woo D, Turner MB; American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics–2014 update: a report from the American Heart Association. Circulation. 2014;129:e28–e292.PubMedCrossRef
9.
go back to reference Morden NE, Colla CH, Sequist TD, Rosenthal MB. Choosing wisely–the politics and economics of labeling low-value services. N Engl J Med. 2014;370:589–592.PubMedCrossRef Morden NE, Colla CH, Sequist TD, Rosenthal MB. Choosing wisely–the politics and economics of labeling low-value services. N Engl J Med. 2014;370:589–592.PubMedCrossRef
10.
go back to reference Moses H 3rd, Matheson DH, Dorsey ER, George BP, Sadoff D, Yoshimura S. The anatomy of health care in the United States. JAMA. 2013;310:1947–1963.PubMedCrossRef Moses H 3rd, Matheson DH, Dorsey ER, George BP, Sadoff D, Yoshimura S. The anatomy of health care in the United States. JAMA. 2013;310:1947–1963.PubMedCrossRef
11.
go back to reference Patel MR, Dehmer GJ, Hirshfeld JW, Smith PK, Spertus JA. ACCF/SCAI/STS/AATS/AHA/ASNC 2009 Appropriateness Criteria for Coronary Revascularization: A Report of the American College of Cardiology Foundation Appropriateness Criteria Task Force, Society for Cardiovascular Angiography and Interventions, Society of Thoracic Surgeons, American Association for Thoracic Surgery, American Heart Association, and the American Society of Nuclear Cardiology: Endorsed by the American Society of Echocardiography, the Heart Failure Society of America, and the Society of Cardiovascular Computed Tomography. Circulation. 2009;119:1330–1352. Patel MR, Dehmer GJ, Hirshfeld JW, Smith PK, Spertus JA. ACCF/SCAI/STS/AATS/AHA/ASNC 2009 Appropriateness Criteria for Coronary Revascularization: A Report of the American College of Cardiology Foundation Appropriateness Criteria Task Force, Society for Cardiovascular Angiography and Interventions, Society of Thoracic Surgeons, American Association for Thoracic Surgery, American Heart Association, and the American Society of Nuclear Cardiology: Endorsed by the American Society of Echocardiography, the Heart Failure Society of America, and the Society of Cardiovascular Computed Tomography. Circulation. 2009;119:1330–1352.
12.
go back to reference Pellegrini LC, Rodriguez-Monguio R, Qian J. The US healthcare workforce and the labor market effect on healthcare spending and health outcomes [published online ahead of print March 21, 2014]. Int J Health Care Finance Econ. DOI: 10.1007/s10754-014-9142-0. Pellegrini LC, Rodriguez-Monguio R, Qian J. The US healthcare workforce and the labor market effect on healthcare spending and health outcomes [published online ahead of print March 21, 2014]. Int J Health Care Finance Econ. DOI: 10.​1007/​s10754-014-9142-0.
14.
go back to reference Stabile M, Thomson S, Allin S, Boyle S, Busse R, Chevreul K, Marchildon G, Mossialos E. Health care cost containment strategies used in four other high-income countries hold lessons for the United States. Health Aff (Millwood). 2013;32:643–652.PubMedCrossRef Stabile M, Thomson S, Allin S, Boyle S, Busse R, Chevreul K, Marchildon G, Mossialos E. Health care cost containment strategies used in four other high-income countries hold lessons for the United States. Health Aff (Millwood). 2013;32:643–652.PubMedCrossRef
Metadata
Title
Defending Waste, Fraud, and Abuse
Author
Joseph Bernstein, MD
Publication date
01-08-2014
Publisher
Springer US
Published in
Clinical Orthopaedics and Related Research® / Issue 8/2014
Print ISSN: 0009-921X
Electronic ISSN: 1528-1132
DOI
https://doi.org/10.1007/s11999-014-3618-6

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