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St Barnabas Settles. According to depositions by a St. Barnabas consultant and two former employees, which were filed in the settlement, the drive for profits soon affected the Medicare billing, and hospital administrators found a way to capitalize on a loophole in the formula Medicare used to determine reimbursements in outlier cases. On one hand, this case is a reminder that the excessively complicated Medicare reimbursement rules make disputes over payments more likely, and make it easier for hospitals (and physicians) to find loop-holes. 2 comments: This is all quite incidental. No matter what details can be carped over, the fundamental fact is this: I beg to differ. Search This Blog. Follow Our Bloggers On Twitter. Your Health Care Watchdog.

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[197] Pressed to get things done quickly by managed care ldquo;utilization reviewers,rdquo; doctors are often not able to perform the full work-up that they need to do. This time limitation on doctors has tremendous implications for the provision of ADHD information. If doctors are not doing the comprehensive and thorough evaluation that is required to diagnose ADHD, they do not know whether a patient truly has the disorder or not. And if they do not know the true condition of the patient, how could they possibly be in a position to provide accurate information to the patient about effective methods of treatment. Lacking a full and complete picture of the patientrsquo;s condition, many doctors have resorted to using ADHD medication as a diagnostic tool and engage in the practice of prescribing medication presumptively. However, for reasons discussed below, this practice is one that is deeply flawed.

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