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    #1

    two practices = two hospitals?

    Context:

    Erie, PA - A new whistle-blower lawsuit filed in US District Court in Erie, PA claims that five cardiologists from two medical practices defrauded Medicare by performing unnecessary cardiac and vascular surgeries and interventional procedures between 2001 and 2005.

  1. emsr2d2's Avatar
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    #2

    Re: two practices = two hospitals?

    They're probably hospitals but basically it just means that the five were not based at the same medical facility. They were based across two different ones.

    In BrE, a practice is normally a doctor's surgery but given the context of the rest of the sentence, I think "hospital" is probably the right interpretation in this piece.
    Last edited by emsr2d2; 27-Jan-2012 at 16:03.

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    #3

    Re: two practices = two hospitals?

    Quote Originally Posted by emsr2d2 View Post
    They're probably hospitals but basically it just means that the two were not based at the same medical facility. They were based at different ones.

    In BrE, a practice is normally a doctor's surgery but given the context of the rest of the sentence, I think "hospital" is probably the right interpretation in this piece.

    Thank you.

    See the full context below, it being"hospital" gets confirmed?

    Cardiologists accused of defrauding Medicare by performing unnecessary cardiac procedures
    January 23, 2012
    Michael O'Riordan

    Erie, PA - A new whistle-blower lawsuit filed in US District Court in Erie, PA claims that five cardiologists from two medical practices defrauded Medicare by performing unnecessary cardiac and vascular surgeries and interventional procedures between 2001 and 2005.

    The suit, filed under the False Claims Act (FCA) and first reported January 22, 2012 in the Erie Times-News [
    1], states that as a result of the fraud, Medicare overpaid for these procedures, which wasted substantial public money, and patients were placed at significant and unnecessary risk of harm.

    According to a copy of the lawsuit obtained by
    heartwire, the physicians named are Drs Richard Petrella, Robert Ferraro, Charles Furr, Timothy Trageser, and Donald Zone. The two medical practices named in the lawsuit are Medicor Associates Inc—and its affiliate Flagship Cardiac, Vascular, and Thoracic Surgery (CVTS)—and the University of Pittsburgh Medical Center (UPMC) Hamot (formerly known as Hamot Medical Center). The Medicor practice is the full-service cardiology center affiliated with UPMC Hamot.

    The lawsuit states that from June 2001 and earlier, the defendants "knowingly, systematically, routinely, and repeatedly submitted false claims to and received reimbursements from Medicare and other federal healthcare programs for medically unnecessary cardiac catheterizations and cardiac and vascular surgical procedures, including but not limited to . . . PCI."

    As result of the false claims, the physicians received money to "which they were not entitled."

    Paid directorships and kickbacks


    Dr Tullio Emanuele, who worked at Medicor and Hamot Medical Center from 2001 to 2005, filed the suit and claims that Medicor engaged in illegal "kickbacks" with Hamot Medical Center and referred cardiac patients to the hospital. In the lawsuit, it is alleged that Hamot signed contracts with Medicor and Flagship CVTS, valued at $75 000 per physician and as high as $525 000 per year, and the doctors would refer patients in need of medical procedures to Hamot Medical Center.

    "Specifically, Hamot identified physicians who referred a high volume of patients and/or had potential to refer a high volume of patients for special treatment and offered remuneration to them in the guise of sham contracts for medical directorships or other similar personal service arrangements," according to the lawsuit.

    The claim states the physicians and the participating hospitals violated the federal Anti-Kickback Statute and the federal Stark Act, which says that a hospital is not allowed to submit a claim for reimbursement from Medicare if the procedure has been referred by a physician with improper financial ties to the hospital.

    The suit also claims that Emanuele began to grow suspicious in 2004 when he noticed higher rates of intervention among certain physicians within the group. Between 2004 and 2005, 4408 catheterizations were performed, and Petrella, Trageser, and Ferraro had a "rate of surgical intervention following catheterization of double the junior members of the group."

    Emanuele, according to the lawsuit, believes that many of the procedures were performed unnecessarily. For example, Trageser is accused of performing a cardiac catheterization in a patient with chest pain, despite the symptomology being inconsistent with angina. Ferraro is accused of implanting a stent in an artery with moderate stenosis, even though Emanuele previously recommended medical therapy. Zone performed a cardiac catheterization and overstated the severity of stenosis, sending the patient on to CABG surgery, where he/she later died.

    UPMC Hamot and the named physicians received copies of the lawsuit last week, according to the Erie Times-News, and have 20 days to respond. If they are found guilty, UPMC Hamot and the Medicor physicians would be required to reimburse Medicare at triple the cost of the original procedure. Emanuele, as the whistle-blower in the case, would be entitled to 30% of the reimbursed money.

  2. Barb_D's Avatar
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    #4

    Re: two practices = two hospitals?

    A practice is just a linked set of offices. If one doctor (or two or three) work together out of one office, that's their practice. You can also have a network of linked offices. One of my doctors is part of a practice that has offices in three towns in the area. Some doctors work out of only one office, some travel between them etc. All share medical records of their patients, billing, etc. The are all owned by the same organization.
    I'm not a teacher, but I write for a living. Please don't ask me about 2nd conditionals, but I'm a safe bet for what reads well in (American) English.

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    #5

    Re: two practices = two hospitals?

    Quote Originally Posted by Barb_D View Post
    A practice is just a linked set of offices. If one doctor (or two or three) work together out of one office, that's their practice. You can also have a network of linked offices. One of my doctors is part of a practice that has offices in three towns in the area. Some doctors work out of only one office, some travel between them etc. All share medical records of their patients, billing, etc. The are all owned by the same organization.

    Cool.
    Gracias/

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