Issue link: https://beckershealthcare.uberflip.com/i/1067786
26 CODING & BILLING Chicago ASC physician convicted in $3.5M billing fraud scheme: 5 things to know By Laura Dyrda P aul Madison, MD, was convicted of healthcare fraud, aggravated identity the and lying about medical treatment delivery aer directing staff to fraudulently bill for procedures at the surgery center where he practiced, according to a Chicago Sun Times re- port. Here are five things to know: 1. Dr. Madison, an anesthesiologist and pain management specialist at Watertower Surgi- Center in Chicago, was convicted of order- ing staff to fraudulently bill for surgeries that weren't performed from 2005 to 2009. 2. Under his direction, Dr. Madison's staff fraudulently billed for more than $3.5 million and wrongly received $783,000, according to an FBI report. 3. In 2007, Illinois state regulators discovered the fraud and at that time, Dr. Madison directed staff members to destroy records and lie to investigators, according to the report. 4. Initially indicted in 2012, a federal jury con- victed Dr. Madison in November 2018, of six counts of healthcare fraud, three counts of lying about medical treatment and two counts of ag- gravated identity the, according to the report. He will be sentenced in March 2019. 5. Dr. Madison's maximum sentence is 79 years in prison. n CMS to pay separately for Exparel, non-opioid pain management at ASCs in 2019 By Laura Dyrda T he CMS 2019 final payment rule for hos- pital outpatient surgery departments and ASCs included an average 2.1 percent reimbursement rate increase per procedure for ASCs, as well as a new code for non-opioid pain management drugs. CMS will now make separate payments for non-opioid pain management drugs for ASCs. The only HCPCS code falling into this category is Exparel, from Pacira Pharmaceuticals, which will now receive separate payment when used in the ASC setting. "Current payment policy serves as an impedi- ment to using non-opioids for postsurgical pain, so this provision addresses our concerns by allowing ASCs to get paid for non-opioid pain relief drugs when used in a surgical procedure," said ASCA CEO William Prentice in a Q&A posted on the ASCA website, in response to the proposed payment update in August. Prior to the final rule's release, Aetna expanded coverage for Exparel to select ASCs in Florida and New Jersey on Oct. 30. The pilot program will reimburse for physicians who use non-opioid therapy for postsurgical pain management at ASCs. The company began reimbursing for Ex- parel in 2017 for select impacted wisdom tooth instructions. The payer also updated its online provider directory to identify surgeons that are trained to administer Exparel. n Temple Surgery Center shutters after Little River Healthcare files for bankruptcy By Angie Stewart R ockdale, Texas-based Little River Healthcare closed all of its facilities and opera- tions Dec. 4 — including Temple (Texas) Surgery Center — due to "unfortunate financial conditions," according to a statement on the system's website. Here's what you should know: 1. The health system filed for bankruptcy in July and filed to liquidate its assets in November. 2. Little River Healthcare facilities including Temple Surgery Center, Killeen (Texas) Spine Program, Killeen Clinic and Salado (Texas) Medical Clinic changed their voicemails to an automated message that said, "Due to an unfortunate turn of events, Little River Health will be shutting its doors immediately." 3. Little River Healthcare Sys- tem staff abruptly lost their jobs when the health system ceased operations. Temple-based Olin E. Teague Veterans' Medical Center organized a job fair Dec. 10 to help the 298 displaced employ- ees find new positions, according to the Temple Daily Telegram. 4. The former webpage for Temple Surgery Center now fea- tures a statement on the closure. The statement provides phone numbers through which patients can request copies of medical records. 5. Little River Healthcare operated the following facilities in Central Texas: • Cameron (Texas) Medical Clinic • Cameron Hospital • Central Texas Weight Loss (Cameron) • Georgetown (Texas) Imaging • Georgetown Orthopedics • Georgetown Physicians' Center • Georgetown Spine Care Pro- gram • Harker Heights (Texas) Wom- en's Center • Killeen Spine Program • Killeen Clinic • Downtown Medical Clinic (Rockdale, Texas) n