Comments for HC Compliance Essentials

Comment on Some Flowers & Some PHI by Lois Mazza

Lois Mazza — Tue, 13 Apr 2010 14:06:29 +0000

I too would like to know how a gift shop employee knew the status of the patient. Must be a SMALL hospital!

Comment on OIG 2010 Work Plan: Physicians’ Imaging Services by Home health compliance: Insulin Injection Rules you should know | Home Healthy

Sat, 10 Apr 2010 03:21:50 +0000

[...] The CMS covers assisted insulin injections when a patient can’t self-inject insulin and there’s no family member or caregiver to lend a helping hand. However, outlier payments for insulin injections have been let loose and putting a check on those payments is top priority for OIG as per the 2010 Work Plan. [...]

Comment on Keep Staff Up to Date on CPR, Physical Restraint Policies by David B.

David B. — Fri, 05 Mar 2010 05:01:25 +0000

Sometimes even if the staff and all involved are aware of patient/clients,history take downs and restraints maybe the only way to handle certain situations. If the proper agencies that are placing these patients/clients were checking that all staff involved were properly trained in take downs and restraining. The State Department of Health should be offering this training to licensed facilities for free or a very minimal cost.Who does offer this training in the Phoenix area if you were to try to find someone where would you look? I just goggled restraint training in the Phoenix area and came up with virtually nothing,but it did lead me to this site.It makes me wonder if there even is anyone certified in this area to train people in take downs and restraining.

Comment on Organized Crime Turns to Health Care Fraud by Gary Brazzell

Gary Brazzell — Tue, 02 Mar 2010 17:58:17 +0000

Thanks for the response and additional info!

Comment on Can an imaging center give a gift certificate to a patient who refers a friend? by Gary Brazzell

Gary Brazzell — Tue, 02 Mar 2010 17:54:01 +0000

Aren’t gift cards a “cash equivalent” and therefore an automatic violation of anti-kickback laws regardless of value?

Comment on Organized Crime Turns to Health Care Fraud by Editor

Editor — Tue, 09 Feb 2010 00:21:04 +0000

Hi Gary: Thanks for writing in. I didn’t deal too much with details in this one, because I’ve written about this topic before in recent months.

For a closer look at how some of these home health fraud schemes work, see this recent Miami Herald article from late last year: http://www.homecarelawblog.com/my-blog/2009/10/health-care-fraud-and-organized-crime.html.

For another perspective, see this post by home care attorney Robert Markette, which explains how determined criminals manage to evade a lot of the safeguards the feds put in place: http://www.homecarelawblog.com/my-blog/2009/10/health-care-fraud-and-organized-crime.html.

Comment on Organized Crime Turns to Health Care Fraud by Gary Brazzell

Gary Brazzell — Tue, 02 Feb 2010 15:16:21 +0000

Unfortunately, to me, this story is a little fuzzy on the details of how the fraud is perpetrated. So is the linked NPR story. All Medicare certified home health agencies must pass rigorous, on-site inspections before they get their provider numbers and routinely afterwards to maintain their Medicare / Medicaid provider numbers. Part of the inspection consists of the inspector showing up with a list of the agencies patients already in hand and asking to go to the patients’ homes, visit with the patients, and see the nurses in action. There is little room for fraud with these types of inspections. I am guessing that the crime story above is saying that this fraud is a type of identity theft in which criminals steal the provider numbers of real home health agencies. But even then, Medicare and Medicaid pay by electronic transfer into a designated bank account.

Comment on HHS Issues New Interim Rule on HIPAA Penalties by HIPAA Privacy Security Expert

HIPAA Privacy Security Expert — Mon, 18 Jan 2010 02:11:54 +0000

Hi,

I would also like to further add few points on New Interim Rule on HIPAA Penalties.

HIPAA establishes criminal penalties for a knowing misuse of unique health identifiers and individually identifiable health information:

• A fine of not more than $50,000 and/or imprisonment of not more than one year
• If misuse is under false pretenses, a fine of not more than $100,000 and/or imprisonment of not more than five years
• If misuse is with intent to sell, transfer, or use individually identifiable health information for commercial advantage, personal gain, or malicious harm, a fine of not more than $250,000 and/or imprisonment of not more than ten years.

The specific offenses to which harsher penalties apply include:

• Using a unique health identifier in violation of the HIPAA requirements for fraudulent purposes. Unique health identifiers include:
• Provider identifiers (effective May 23, 2007)
• Employer identifiers (currently in effect)
• Health plan identifiers (the rule for which has yet to be drafted by CMS)
• Individual identifiers (not likely to be defined and publication of a rule is unlikely)
• Obtaining or using individually identifiable health information in violation of the HIPAA privacy requirements
• Disclosing individually identifiable health information in violation of the HIPAA privacy requirement

In addition to significant financial penalties, remaining noncompliance might result in these additional consequences:
• Claims not honored
• Bad press
• Loss of reputation
• Legislative or state audits
• State law violations (such as of consumer protection laws)
• Civil lawsuits (HIPAA doesn’t provide for any private right of action, but that doesn’t prevent individuals filing suits for damages.)

Comment on Prepare for Increased Fraud Enforcement with Medicaid Compliance Plan by Kauian HME

Kauian HME — Tue, 12 Jan 2010 16:12:07 +0000

In rural areas like ours, access to care for Medicaid patients is seriously threatened by these kinds of measures. The instability of insurers who actually manage Medicaid programs makes looking at going non-par really attractive. The really disgusting part is that nearly all of this overkill in regulation is because of greed and lack of integrity by a minority – a growing minority it seems – of suppliers. Naturally the feds and the states respond by carpet-bombing the industry. That takes out not only the bad guys, but also a lot of the good guys and – worst of all – a lot of the people who could be served were it not for the dishonesty of some and the overreaction of government.

Comment on Keep Staff Up to Date on CPR, Physical Restraint Policies by Gerald W. Bolton

Gerald W. Bolton — Tue, 05 Jan 2010 21:51:30 +0000

One thing very which we found out on our behavioral health unit is that it is extremely important to know the medical history of patients along with the psychiatric/psychological history. I formed a Behavioral Management Performance Improvement committe to dicuss what we can do differrent with patients with cardiac/stroke histories, geriatric issues such as dementia and alzhiemers and patients with sexual assault histories. Knowing these histories becomes very important when dealing with aggitation and anxiety without reaching the point where staff are doing take downs and restraints risking a possible cardiac/respiratory arrest or psychological trauma. This of course requires alot of verbal interventions and staff that are also advocates for those they are caring for.