CMS Issues Notice Warning Physicians to Protect Medicare Provider Identification Numbers from Fraudulent Employees

While working with the Centers for Medicare and Medicaid Services (CMS), the California Benefit Integrity Support Center discovered a fraud scheme. Fraudulent employers offer contracts to physicians for reviewing charts, interpreting tests, or supervising clinical staff and operations. Their goal is to obtain the physician Medicare provider identification numbers (PINs), so they can submit multiple claims for one patient. According to the notice, these fraudulent employers recruit health professionals through residency programs, by word of mouth, or advertisements in newspapers. They offer a percentage or a monthly or annual fee for physician services. In exchange, the physicians are asked to sign a contract allowing the use of the physician’s PIN and making the physician the billing provider for the clinic. Another option is opening a joint bank account for Medicare reimbursements to which the fraudulent employer has direct access. CMS will demand repayment from the physician for fraudulent claims on that PIN, and the physician could be prosecuted for fraud. More information is available online athttps://www.aafp.org/x28200.xml. Information about Medicare fraud, tips for recognizing it, and ways of reporting it are provided by CMS online athttp://www.cms.hhs.gov/providers/fraud.

Veterans Returning from Combat Zones Rely on Family Physicians for Mental Health Screening

In July, New England Journal of Medicine published an article with the results from a survey of more than 6,000 troops who served in Iraq and Afghanistan. According to the article, combat veterans, particularly those returning from Iraq, have significantly higher rates of mental illness than their noncombat colleagues or the general public. At highest risk for major depression, anxiety, or post-traumatic stress disorders are soldiers who were wounded, handled bodies, killed enemy combatants, or knew someone who was killed. Barriers to mental health care and concern about stigma prevented many military personnel from getting help. The article recommends that family physicians routinely screen combat veterans for mental illness and increase the use of primary care clinics for mental health services. The study is available online athttp://content.nejm.org/cgi/content/full/351/1/13. More information on helping military personnel is available online athttps://www.aafp.org/fpr/20040600/10.html andhttps://www.aafp.org/fpr/20040600/11.html.

AAFP, CDC, and Others Recommend Increasing Number of Doses of Pediatric Pneumococcal Conjugate Vaccine

In July, the Centers for Disease Control and Prevention (CDC), the American Academy of Family Physicians (AAFP), the Advisory Committee on Immunization Practices, and the American Academy of Pediatrics recommended that physicians increase the number of doses of pneumococcal conjugate vaccine administered to healthy children from two to three, and continue to give the full four-dose series to children up to 15 months of age who have chronic conditions, such as sickle cell anemia or immune system disorders. The groups said the fourth dose of the vaccine in healthy children should be deferred until production and supplies are adequate. In February 2004, the CDC recommended suspension of the fourth dose of the vaccine when the manufacturer reported it would not be able to produce enough to meet demand. In March, the CDC recommended the third dose also be withheld because supplies of the vaccine would be low for several months. The groups recommend a catch-up schedule for children who missed the third dose. The highest priority is for children at high risk for invasive pneumococcal disease; second priority is children younger than 24 months who have not received any doses of the vaccine; and third priority is children younger than 12 months who have not received three doses of vaccine. More information is available online athttp://www.cdc.gov/od/oc/media/pressrel/r040708.htm andhttp://www.cdc.gov/nip/news/shortages/. For the AAFP policy on the recommendation, go tohttps://www.aafp.org/x1556.xml.

AAFP Supports New Legislation that Includes Care Management Fee

The AAFP supports the Geriatric and Chronic Care Management Act introduced by Sen. Blanche Lincoln (D-Ark.). The legislation authorizes payment for geriatric assessment and care management for Medicare beneficiaries, which incorporates elements of the care management fee concept advocated by the AAFP. The concept proposes that a fee be paid to the patient’s personal physician to coordinate the patient’s health care, including tracking and monitoring all aspects of care; referring the patient to other health care professionals and coordinating clinical reports; maintaining the patient’s health record; and spending more time with the patient as needed. This fee would be paid per-patient-per-month by Medicare, Medicaid, or private insurance plans as appropriate. Making the care management fee part of the reimbursement system would ensure that these services are available to everyone and not exclusive to those who can afford to pay more for health care. More information is available online athttps://www.aafp.org/x28401.xml. To read the bill, go tohttp://thomas.loc.gov and type S.2593 in the Bill Number search box.

NHLBI Updates Cholesterol Guidelines for Higher-Risk Patients

In July, the National Heart, Lung, and Blood Institute (NHLBI) updated the National Cholesterol Education Program’s (NCEP’s) clinical practice guidelines on cholesterol management. The update advises physicians to consider new, more intensive treatment options for patients at high and moderately high risk for a heart attack, including setting lower treatment goals for low-density lipoprotein (LDL) levels and starting cholesterol-lowering drug therapy at lower LDL levels. For high-risk patients, the LDL goal remains less than 100 mg per dL. For patients at very high risk, the goal is less than 70 mg per dL. The update was endorsed by the American Heart Association (AHA), the NHLBI, and the American College of Cardiology. NHLBI coordinates the NCEP. The complete report was published in the July 13 issue of Circulation, the journal of the AHA. Updated guidelines and related resources are available online athttp://www.nhlbi.nih.gov/guidelines/cholesterol/index.htm. Additional information is available online athttp://www.nih.gov/news/pr/jul2004/nhlbi-12.htm.