A Medical Device Daily

BlueCross BlueShield of Tennessee (BCBS-T; Chatanooga, Tennessee) has agreed to pay the United States $2.1 million to settle allegations of violating the False Claims Act, the Justice Department reported. BCBS-T, operates as Riverbend Government Benefit Administrators.

The settlement resolves allegations that BCBS-T, while the primary Medicare Part A Fiscal Intermediary for the state of New Jersey, failed to adjust the cost-to-charge ratios for many New Jersey hospitals in a timely manner between 2000 and 2002 that resulted in the payment of excessive "outlier payments" by Medicare program to those medical facilities. A Part A Fiscal Intermediary is a private insurance company that processes and pays Medicare claims.

In addition to its standard payment system, Medicare provides supplemental reimbursement, called outlier payments, to hospitals in cases where the cost of care is unusually high. Congress enacted the supplemental outlier payment system to ensure that hospitals possess the incentive to treat inpatients whose care requires unusually high costs.

The settlement with BCBS-T was the result of a coordinated effort among the Justice Department's Civil Division's Commercial Litigation Branch; the U.S. Attorney's Office for the District of New Jersey, Affirmative Civil Enforcement Unit; the Department of Health and Human Services, Office of Inspector General and Office of Counsel to the Inspector General; the Centers for Medicare and Medicaid Services; and the FBI, in investigating and resolving the allegations.

In other legalities, A U.S. district court in Texas has granted Pressure Products' (Santa Barbara, California) request to permanently enjoin sales of Enpath's (Minneapolis) ViaSeal valved peel-away introducer, effective immediately.

The court also granted Pressure Products' request to permanently enjoin sales of Enpath's FlowGuard valved peel-away introducer.

The court temporarily stayed the injunction against FlowGuard only, pending possible review of the matter by the court of appeals, should Enpath choose to appeal. The temporary stay is not based on a consideration of the merits of any appeal by Enpath but is entered to preserve the status quo while the court of appeals considers the matter.

If Enpath chooses not to appeal or if Pressure Products prevails on appeal, as it did recently in the district court, the temporary stay is dissolved and the permanent injunction becomes effective immediately.

"We are pleased with the court's ruling and are moving forward aggressively to build sufficient product inventories to support the increased demand for our vascular sheath product lines," said Dr. Paul Kurth, president of Pressure Products.

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