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:
This past August, the United States Department of Health and Human Services (HHS) Office for Civil Rights (OCR) received a complaint that Housing Works Inc., out of New York, had failed to provide a patient with a copy of his medical records. The patient argued that the health care organization’s failure to provide the requested information was a violation of the patient’s rights under the Health Insurance Portability and Accountability Act (HIPAA). This compliant triggered an investigation. Upon facing the allegations, the healthcare provider chose to settle the claim instead of fight back.
The United States Food and Drug Administration (FDA) conducts investigations of certain pharmacies to determine whether or not the facility's practices are in line with Food Drug and Cosmetic (FD&C) Act and related laws. The FDA's Offices of Regulatory Affairs inspectors conduct the investigation and make observations about practices within the pharmacy, noted with FDA Form 483. The observations within this form are based on the "investigator's judgment, conditions, or practices observed" that could indicate a potential violation.
The government continues to crackdown on the commission of health care fraud throughout the country. In a recent case, the United States Department of Justice (DOJ) announced that it will expand the number of former National Football League (NFL) players it will take to court in a current health care fraud case.
Health care fraud cases generally follow the following timeline: the government becomes aware of a potential offense, an investigation occurs, and the government pursues criminal charges if the investigation leads to evidence to support the allegations. It may seem like a relatively straightforward process, but the reality can be circuitous and time consuming. A recent case provides an example.
A diagnostic laboratory recently agreed to pay the government almost $12 million to settle claims that the health care company violated federal Anti-Kickback Statute (AKS) regulations. The government claimed that individuals within the diagnostic lab were illegally bribing health care professionals to use the professional services offered within their lab.
Authorities recently announced the sentencing of a registered nurse (RN) to 18 months imprisonment for her role in a health care fraud scheme. As part of the sentence, the court has also required the nurse to pay $9,500 in restitution.
The United States Department of Justice (DOJ) and the Office of the Inspector General (OIG) have stated they will aggressively pursue health care fraud claims related to COVID-19. These agencies further clarify that they will continue to focus on prosecution for violations of the Eliminating Kickbacks in Recovery Act (EKRA). The announcement comes at an uncertain time, when diagnostic labs are working to help patients who are waiting for testing while living amidst a global pandemic.
The answer depends on the details of the allegations. In a recent case, a group of patients filed a class action lawsuit against a New York health system accusing the group of failing to protect their financial, medical and personal information from security leaks. The failure, they allege, resulted in a cyber attack that put the privacy of information like social security numbers in jeopardy.
A recent case out of New York provides multiple examples of what not to do if accused of health care fraud. The case began when the U.S. Attorney's Office of the Western District of New York investigated a psychiatric physician for health care fraud. According to the prosecution, the physician billed for the highest level of evaluation appointments when seeing new patients. When questioned about the need for such an inclusive appointment, the government claims he was unable to provide sufficient evidence to support the claim. Upon further investigation, the government claims the physician routinely up coded and improperly billed for services.