{"id":31525,"date":"2012-08-30T23:32:19","date_gmt":"2012-08-31T03:32:19","guid":{"rendered":"http:\/\/blogs.nejm.org\/cardioexchange\/?post_type=news&#038;p=31525"},"modified":"2012-08-31T15:39:16","modified_gmt":"2012-08-31T19:39:16","slug":"icd-investigation-doj-sends-resolution-model-to-hospitals","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/cardioexchange\/2012\/08\/30\/icd-investigation-doj-sends-resolution-model-to-hospitals\/","title":{"rendered":"ICD Investigation: DOJ Sends Resolution Model to Hospitals"},"content":{"rendered":"<p>Hospitals across the country received emails from the U.S. Department of Justice on Thursday containing a proposed &#8220;Resolution Model&#8221; that will allow the hospitals to begin to settle the long-standing and much-feared DOJ investigation into improper Medicare billing for ICDs. The action appears to confirm an article,\u00a0<a title=\"Guest Post: Feds Turn Corner in ICD Investigation; Hospital Liability Divided into\u00a0Categories\" href=\"http:\/\/cardiobrief.org\/2012\/08\/07\/guest-post-feds-turn-corner-in-icd-investigation-hospital-liability-divided-into-categories\/\">published earlier in August in\u00a0<em>Report on Medicare Compliance<\/em><\/a>,\u00a0that\u00a0summarized the key details of the novel program.<\/p>\n<p><a href=\"http:\/\/www.modernhealthcare.com\/article\/20120830\/NEWS\/308309943#ixzz254abaKjF\">As reported by ModernHealthcare.com<\/a>\u00a0(free registration), the\u00a0<a href=\"http:\/\/www.modernhealthcare.com\/assets\/pdf\/CH81623830.PDF\">document<\/a>\u00a0sent to hospitals contains &#8220;instructions to examine questionable implantable defibrillator surgeries on Medicare patients and estimate potential penalties under the False Claims Act.&#8221; Some hospitals, according to the story, &#8220;have been asked to provide information of hundreds of cases each.&#8221;<\/p>\n<p>Hospitals are being asked to perform audits on their cases and to estimate damages, &#8220;with the severity of penalties based on whether the hospital had medical reasons to violate CMS rules; if patient harm resulted; if the hospital had prior knowledge or a statistical pattern of non-guideline implants; and if a hospital compliance program was in place.&#8221;<\/p>\n<p>Here is the DOJ Resolution Model Summary Chart:<\/p>\n<p><a href=\"http:\/\/blogs.nejm.org\/cardioexchange\/wp-content\/uploads\/sites\/7\/2012\/08\/DOJ-Summary-Chart.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignright size-large wp-image-31529\" title=\"DOJ Summary Chart\" src=\"http:\/\/blogs.nejm.org\/cardioexchange\/wp-content\/uploads\/sites\/7\/2012\/08\/DOJ-Summary-Chart-791x1024.jpg\" alt=\"\" width=\"791\" height=\"1024\" \/><\/a><\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Hospitals across the country received emails from the U.S. Department of Justice on Thursday containing a proposed &#8220;Resolution Model&#8221; that will allow the hospitals to begin to settle the long-standing and much-feared DOJ investigation into improper Medicare billing for ICDs. The action appears to confirm an article,\u00a0published earlier in August in\u00a0Report on Medicare Compliance,\u00a0that\u00a0summarized the [&hellip;]<\/p>\n","protected":false},"author":196,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[13,1],"tags":[938,1268,448,474],"class_list":["post-31525","post","type-post","status-publish","format-standard","hentry","category-electrophysiology","category-general","tag-cms","tag-doj","tag-icds","tag-medicare"],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/31525","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/users\/196"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/comments?post=31525"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/31525\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/media?parent=31525"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/categories?post=31525"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/tags?post=31525"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}