MSA Surgery Mystery Solved

Commentary, Medicare Set-Aside Blog, MSP Litigation on September 26, 2014
Posted by Jennifer Jordan, JD, MSCC

Surgical Screw




After years of reviewing medical records and surgery pricing, I could never figure out what made surgical screws so expensive. Those screws look a lot like the ones we get bags full of at IKEA with any piece of furniture and I can furnish an entire room with what one pedicle screw costs. Now it all makes sense.

The DOJ is currently pursuing claims under the False Claims Act against certain manufacturers that paid physicians to use certain spinal implants. Said manufacture is physician owned, as are the 12 physician owned distributorships that sold its devices. Allegations also reference excessive or medically unnecessary surgeries performed by said owners who were also paid very well for the surgery itself. Hmmmm, wait – people undergo spinal surgeries that they really don’t need???

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While narcotic drugs are by far the biggest cost driver in MSAs, you need to keep in mind how the claimants got them. Whether they were started on that path on the date of injury with a bottle of Percocet or an Actiq lollypop the Cephalon rep left as samples in the physician’s office after a round of golf, or they received unnecessary spinal surgery and now mysteriously suffer from failed back syndrome and have real pain, some physician with an ulterior motive may be responsible for your MSA problems. And the only thing more unconscionable than these practices by people working under an oath to do no harm is the presumption by CMS that their actions deserve deference and should serve as the basis for lifetime medical expenses.

I look forward to following this litigation and hope that the DOJ and CMS share notes: