The Morning Drill: December 14, 2011

Good Morning!

On to today's dentistry and health headlines:

Rainier dental hygienist charged with stealing $14,500 from DSHS Medicaid

A Rainier dental hygienist has been charged with stealing more than $14,500 from the state Department of Social and Health Services’ Medicaid program.

On Thursday, the state Attorney General’s Office filed eight criminal charges against 57-year-old Karen Ann Lockhart – five counts of first-degree theft, two counts of second-degree theft and one count of making a false statement for Medicaid reimbursement, according to criminal information filed in Thurston County Superior Court.

Lockhart could not be reached for comment Tuesday.

According to a probable-cause statement, also filed last week:

The Attorney General’s Medicaid Fraud Unit began an investigation of Lockhart, who owns and operates Rainier Dental Hygiene Services, in January 2010.

The investigation began when DSHS’s Medical Audit Unit sent a referral to the Attorney General’s Office after DSHS performed an audit examining three years of Lockhart’s billing practices.

In 2002, Lockhart had signed a contract to provide dental hygiene services to DSHS’s Medicaid clients. Most of Lockhart’s clients received their treatment in skilled-nursing facilities and in “supported/assisted living environments.”

“As a result of the audit, an overpayment to Lockhart in the amount of $177,884.49 was identified,” court papers state. “As a result of the audit, Lockhart’s provider agreement was terminated effective January 20, 2010.”

FDA Warns Surgery Centers to Drop 'Misleading' Lap-Band Ads

Eight California surgical centers and an affiliated marketing firm have been warned by the US Food and Drug Administration (FDA) to drop "misleading" ads for laparoscopic adjustable gastric banding (LAGB) that fail to inform patients about the risks of the weight-loss procedure.

The Los Angeles Times reports that since 2009, at least 5 individuals have died after they underwent the procedure at clinics targeted by the FDA.

The marketing firm in question, 1-800-Get-Thin, has swamped southern California with highway billboards, bus placards, and advertising inserts touting LAGB performed with the Lap-Band Adjustable Gastric Banding System (Allergan). The advertising features trim, smiling men and women who testify to losing as much as 130 pounds through the procedure, described as "Safe, 1-Hour, FDA Approved."

The Lap-Band is one of 2 devices approved by the FDA for gastric banding. Both bands wrap around the upper part of the stomach to form a pouch. The narrowed opening can be adjusted to control the flow of food into the main part of the stomach. The band limits how much a person can eat and thereby helps create a sense of fullness that curbs appetite.

The Lap-Band is indicated for adults age 18 or older who have not lost weight with nonsurgical methods and have either a body mass index (BMI) of at least 40 kg/m2 or a BMI of 30 kg/m2 or more and at least 1 health problem related to obesity.

The FDA announced today that it had issued its warning letters to 1-800-Get-Thin and the surgical centers earlier this month. In those letters, the FDA complains that the Lap-Band advertising omits warnings, precautions, contraindications, and possible side effects of the procedure. The warnings in some of those ads that instruct would-be patients to consult their physicians about risks and to read online safety information "may be so small as to render the information illegible," the agency added.

The risks of the surgery, which include death, are heightened for obese individuals, according to the FDA. Risks after the Lap-Band procedure include nausea and vomiting, difficulty swallowing, gastroesophageal reflux disease, stretching of the stomach pouch, and the need for further surgery when the band shifts position or erodes into the stomach.

"FDA's concern is that these ads glamorize the Lap-Band without communicating any of the risks," Steven Silverman, director of the Office of Compliance in the agency's Center for Devices and Radiological Health, said in a press release.

House Okays Medicare 'Doc Fix' That Appears Doomed in Senate

Setting up physicians for another likely disappointment, the House today passed a bill that would avert a 27.4% reduction in Medicare reimbursement scheduled for January 1.

The disappointment will probably come compliments of the Senate, where Democrats have vowed to block the legislation. Their ire is aimed not at the latest "doc fix" to the Medicare reimbursement crisis but, rather, at other provisions regarding a payroll tax cut and the controversial Keystone XL oil pipeline.

Approved in a 234-193 vote, the House bill would extend a temporary cut to the Social Security payroll tax paid by workers for 1 more year, keeping it at 4.2%. Without this renewal, the tax will return to its former level of 6.2% on January 1. House Republicans propose paying for the extension by, among other things, increasing Medicare premiums for high-income beneficiaries and freezing compensation for federal workers through fiscal 2013. Senate Democrats, however, want to offset the cost by imposing a surtax on millionaires, a move already kiboshed by their Republican opponents.

Another contested provision in the House bill would require the Obama administration to reach a decision within the next 60 days on a permit for the proposed Keystone XL pipeline, which would carry Canadian crude to Texas. Republicans contend that the pipeline will not only improve the country's energy security but also create thousands of jobs.

The Obama administration had put off the permit decision off until 2013, ostensibly to gain more time to study the project's environmental ramifications. Pundits also think the White House would rather make the decision, which pits jobs against environmental safety, until after the 2012 presidential election. Senate Democrats want the pipeline divorced from the payroll cut extension, and Obama has threatened to veto any bill that combined the 2 items.

Latest Doc Fix Would Lead to 37% Cut in 2014

Seemingly lost in the gunpowder clouds of partisan politics, once again, is the latest doc fix to the Medicare reimbursement crisis. The House bill passed today would essentially postpone a pay cut for 2 years and, instead, give physicians a 1% raise in both 2012 and 2013.

The bill requires Congress, in the meantime, to work with the Medicare Payment Advisory Commission, the Governmental Accountability Office, and the Department of Health and Human Services to replace Medicare's current method for setting physician reimbursement, called the sustainable growth rate (SGR) formula. This formula, approved by Congress in 1997, is responsible for triggering the massive pay cut set for 2012.

Policymakers will feel mounting pressure to devise a replacement: In 2014, the SGR formula will call for an estimated 37% cut in physician pay, according to the Congressional Budget Office.

Survey: Doctors Have Mixed Feelings About Health Law

Doctors’ feelings about the health-care overhaul law passed last year are about as mixed as their patients’, research released today shows.

Some 44% of doctors said the law was “a good start,” according to a survey carried out by the Deloitte Center for Health Solutions consulting group. Another 44% agreed that the law was “a step in the wrong direction.”

Many of the 501 physicians surveyed indicated that they had sour feelings about specific aspects of the law.

Around three-fourths of the doctors worried about physician shortages and longer wait times as more people get health coverage, and also that emergency rooms would become overwhelmed. And 90% thought they would be paid less by insurance companies as a result of the law.

Seven out of ten believe that some would-be doctors won’t go into the profession now, and 60% think some physicians might retire because of the law.

The survey had some less-than-surprising results, too: three-quarters of physicians favor tort reform to limit the amount that can be awarded to victims of medical malpractice.

Surgical specialists were angriest about the law — 60% of those participating in the survey said they opposed it, compared with 39% of primary-care providers and 36% of other specialists.

Enjoy your morning!