Re: another Her2 neu question

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From:"Vinnie Della Speranza" <>
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while I hear what you are saying, and I share your consternation, I don't think that we can assume that because this information isn't requested or reported that it couldn't be discovered. I am referring to the billing compliance issues that occupy so much of our attention these days. Are you willing to risk being inspected and having it discovered later that your facility was paid to treat patients with Herceptin when you didn't comply with the insurance carrier's requirements for determining patient eligibility with the Hercept test? Are you absolutely certain that there would be no repercussions down the road.   My facility just paid a large fine to IOG to settle a lawsuit alleging fraudulent billing practices to avoid having to go to court to  try to prove otherwise because the outcome of a lengthy trial is always uncertain. The third party payors are insisting that an FDA approved method be used. as far as I know, Dako is the only one with that distinction. It may not even be Dako behind all of this. 


Vinnie Della Speranza
Manager for Anatomic Pathology Services
Medical University of South Carolina
165 Ashley Avenue
Suite 309
Charleston, SC  29425
ph:  (843) 792-6353
fax: (843) 792-8974

>>> <> 05/25/00 07:31PM >>>
dear vinnie
As far as I know , no insurance carriers ask methodology of  results, they 
treat breast cancer(tamoxifen) based on  all our various methods and clones, 
does this not set a precedent? Insurance carriers still allow the pathologist 
to render diagnosis, based on their judgement and all our different systems. 
How dare any one company place fear into us? HCFA forms only ask for 
procedure codes and diagnosis, no place on form as of yet for company of 
antibody or detection. We are all using same code to bill for IHC right? How 
would any company know anything else?                                         

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