A 73-year-old surgeon recently filed a case against his former employer. He claims hospital officials discriminated against him based on his age when they had him undergo a neuropsychological and physical exam as well as have a proctor present when he conducted surgical procedures. The hospital executives disagree. They state their requirements were warranted because the surgeon's actions resulted in the death of a patient.
NY podiatrist agrees to pay $1.25M to settle FCA claim
Government officials recently accused a local New York City hospital system along with a podiatrist of fraudulent billing practices. The allegations are in connection with a whistleblower lawsuit. The whistleblower brought the claim forward in 2012, stating the hospital and the podiatrist violated the False Claims Act (FCA) when they submitted claims for expenses related to the training of podiatric residents.
Anatomy of an OPMC investigation
What happens when a patient, co-worker or other medical professional files a complaint about a physician's work? If the complaint involves allegations of misconduct, the New York Health Department's Office of Professional Medical Conduct (OPMC) and state Board for Professional Medical Conduct will generally work in conjunction to investigate the complaint. These investigations can result in criminal charges and revocation of one's medical license. As such, it is important to understand how the process works.
Whistleblower begins FCA case against dentist
A former employee recently filed a claim against a dentist. In this claim, the worker does not allege that they were personally injured. In fact, the claim does not even directly involve the worker. Instead, the claim states the dentist and oral surgeon fraudulently billed Medicaid for dental restoration services and x-ray images, a False Claims Act (FCA) violation. According to the claim, the services and images were either never provided in the first place or medically unnecessary.
Tips to reduce liability for telehealth services
The Department of Health and Human Services has relaxed regulations under the Health Insurance Portability and Accountability Act (HIPAA), at least temporarily. This allows medical professionals to conduct communications with patients using technology like Zoom and Google Hangouts. Although helpful for both physicians and patients during the current pandemic, there are concerns about liability for those providing these services.
Three specific areas that require careful consideration include patient privacy, diagnosis issues and communication concerns.
3 things diagnostic labs need to know about regulatory compliance
Laws and regulations are present to better ensure diagnostic labs provide quality care. A failure to abide by these regulations can result in serious penalties. There are many government agencies that oversee these regulations. The United States Department of Health and Human Services (HHS), Centers for Medicare and Medicaid Services (CMS), the Food and Drug Administration (FDA) and the Centers for Disease Control and Prevention (CDC) are a few of the more prominent federal agencies that diagnostic labs may encounter.
Lessons from record setting HIPAA fine
The United States Department of Health and Human Services (HHS) recently announced a $6.85 million settlement with Premera Blue Cross, a private health insurance provider, to settle claims the company violated the Health Insurance Portability and Accountability Act (HIPAA). The provider is also required to implement a “robust corrective plan” that will include two years of monitoring to reduce the risk of similar incidents in the future.
NJ healthcare insurance negotiation deal: 3 lessons
New Jersey healthcare company Humana Inc. recently adjusted its insurance offerings to expand in-network access for members. After much negotiations with local healthcare providers, the private insurance provider agreed to expand its terms to include additional physician practices.
Is my physician group patient-centric?
The term patient-centric is a popular, sometimes overused, catch phrase within the healthcare industry these days. Although overuse is problematic, there is value to reviewing your practice’s business plan to make sure the culture provides a positive patient experience. Physician groups looking to conduct an internal audit on the matter and make changes to better ensure a welcoming and patient focused experience can benefit from the following tips:
Why should my diagnostic lab care about compliance?
Gravity Diagnostics, a CLIA diagnostic and testing laboratory licensed to provide services throughout the country, recently announced the addition of an executive. Although the addition of another executive for this large of an organization on its own is not of note, the job description for this position is: chief compliance officer. The lab's owners moved to hire this executive solely for the purpose of better ensuring the lab is compliant with all applicable regulations - both state and federal.
The move highlights the importance of regulatory compliance in the lab industry.
