Becker's Spine Review

12 SPINE SURGEONS Prosecutors fight spine surgeon's plea for new trial after $40M Texas kickback dispute By Alan Condon P rosecutors argued in a federal court Nov. 11 that Michael Rimlawi, MD, should not be granted a new trial aer he was convicted for his role in a $40 million kickback dispute in April, Law360 reported. Texas spine surgeon Dr. Rimlawi is sought a new trial as he contends the federal Anti-Kick- back Statute — the law under which he was convicted — is unconstitutionally vague. Dr. Rimlawi and three other physicians were convicted aer a jury found them guilty of bribery and both paying and accepting kickbacks. It was found that the now-defunct Forest Park Medical Center in Dallas illegally paid for operations to enhance its bottom line before it closed. Prosecutors argued in April that the physicians agreed to refer patients to FPMC in ex- change for money to advertise their practices, which helped some of their practices grow significantly. It was the first time that North Texas prosecutors used the Travel Act, a federal law, to win kickback and bribery convictions against healthcare workers who evaded federal insur- ance programs such as Medicare to avoid such an outcome, according to e Dallas News. Prosecutors argued Nov. 11 that Dr. Rimlawi failed to make the case that the jury's April verdict was error-ridden and should be voided. n CMS removes 6 spinal procedures from inpatient-only list By Alan Condon C MS removed six spinal procedures from the inpatient-only list in the CY 2020 Medicare Hospital Out- patient Prospective Payment System and Ambulatory Surgical Center Payment System Final Rule, issued Nov. 1. The changes, which take effect Jan. 1, will enable the procedures to be paid by Medicare in both the hospital outpatient and inpatient settings. The six spinal procedures removed from the IPO list: 1. Arthrodesis, combined posterior or posterolateral technique with posterior interbody technique including laminec- tomy and/or discectomy sufficient to pre- pare interspace, single interspace and segment; lumbar. CPT code: 22633 2. Arthrodesis, combined posterior or posterolateral technique with posterior interbody technique including laminec- tomy and/or discectomy sufficient to pre- pare interspace, single interspace and segment; lumbar; each additional inter- space and segment. CPT code: 22634 3. Laminectomy for excision or evacua- tion of intraspinal lesion other than neo- plasm, extradural; cervical. CPT code: 63265 4. Laminectomy for excision or evacua- tion of intraspinal lesion other than neo- plasm, extradural; thoracic. CPT code: 63266 5. Laminectomy for excision or evacua- tion of intraspinal lesion other than neo- plasm, extradural; lumbar. CPT code: 63267 6. Laminectomy for excision or evac- uation of intraspinal lesion other than neoplasm, extradural; sacral. CPT code: 63268 Read the IPO changes for spinal proce- dures on page 669 of the OPPS/ASC final rule. n California spine surgeon sentenced to 30 months in prison after $5M kickback scheme By Alan Condon S pine surgeon Daniel Capen, MD, was sentenced to 30 months in pris- on Nov. 22 after pleading guilty to conspiracy and receiving kickbacks at the now-defunct Pacific Hospital of Long Beach, Calif., the Long Beach Post News reported. Dr. Capen received more than $5 million in kickbacks to perform hundreds of spinal surgeries at the hospital. He referred patients to Pacific Hospital and used medical devices from a company affiliated with the hospital to perform surgeries. Prosecutors said Dr. Capen was responsible for roughly $142 million of the hospital's insurance claims between 1998 and 2013, for which it was paid around $56 million. He was among several physicians paid to refer patients to Pacific Hospital for surgeries in a 15-year scheme. Ten people have been convicted for their roles in the kickback scheme, including the hospital's owner Michael Drobot, who is serving a five-year sentence. n

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