Federal prosecutors, who in the early years of managed care were often drawn to quality-of-care cases stemming from the underutilization of services, particularly at nursing homes, are giving renewed emphasis to the problem of overutilization, San Diego U.S. Attorney Carol Lam said at a conference in Chicago. "There are more players competing for fewer dollars," Lam said. Cases involve not only the classic problem of billing for unnecessary or undelivered services and procedures but also "intent to corrupt physicians' medical judgment," such as paying kickbacks to doctors to prescribe certain drugs or refer patients to certain hospitals, she said. Lam's office is prosecuting two hospital executives at Tenet Healthcare Corp.'s Alvarado Hospital Medical Center, San Diego, for the alleged payment of kickbacks. She did not discuss the Alvarado trial, which is entering its fourth week. -- by Mark Taylor
Overutilization once again draws prosecutors' eyes
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