Medicare Test, Procedure Growth Under Scrutiny

When are hospitals providing necessary healthcare services, and when are they padding the bottom line? That's a question more hospitals might want to examine given recent news reports documenting rapid Medicare spending growth--and recent actions by the U.S. Department of Justice (DOJ) to pursue False Claims Act (FCA) allegations that increasingly focus on whether hospitals "put profits ahead of sound medical judgment" as described by Tony West, assistant attorney general for the DOJ's Civil Division, in the May 18 announcement [1] of a nine-hospital, $9.4 million settlement to resolve FCA cases involving inpatient claims for the spinal procedure kyphoplasty.