The North Carolina Medical Society has posted a summary of their efforts and accomplishments, along with the Physicians Advocacy Institute, with respect to managed care in 2011. The NCMS states that according to their member surveys, reimbursement issues are the number one frustration for physicians.
Read the entire post here.
February 2nd, 2012
The videos will be released each week over a three month period. So far, topics of interest have included compliance programs, the self-referral law, the false claims act, the anti-kickback statute, among others.
You can access all of the Provider Compliance Training videos and audio podcasts here.
February 2nd, 2012
U.S. to force drug companies to report money paid to doctors by for research, consulting, speaking, travel and entertainment.
The full article is here.
February 2nd, 2012
A Washington Post article reports that large insurers, UnitedHealth Group being the biggest example, are quietly buying doctors groups in an effort to more tightly manage the provision of healthcare. The trend reflects efforts by insurers to control costs by shifting physicians’ financial incentives away from performing more procedures and toward more cost-effective care. Consumer advocates are nervous about the implications, expressing fears that patients may be denied needed services and procedures on the basis of cost to the insurer; while the insurers themselves assert the new structure represents a change in the world of healthcare provision that will ultimately benefit consumers and better prepare doctor groups to meet the responsible care objectives of the healthcare reform bill.
Read the entire article here.
July 18th, 2011
The Department of Health and Human Services Office for Civil Rights will settle claims of violations of the HIPAA Privacy and Security Rules against the University of California at Los Angeles Health System for $865,500 and a commitment to a corrective action plan.
The complaints filed with OCR alleged that unauthorized system employees accessed and viewed the electronic protected health information of numerous patients, including two celebrity patients. Entities covered under HIPAA must have policies and procedures in place that reasonably restrict access to such protected information to employees with a valid reason to view it.
To view the resolution agreement and corrective action plan, see here.
The HHS press release is available here.
July 13th, 2011
Brooklyn neurologist Dr. Leonard Langman has pleaded guilty to one count of health care fraud. Between January 2006 and December 2009, Dr. Langman defrauded Medicare, the U.S. Department of Labor, the Office of Workers’ Compensation Programs, the New York State Workers’ Compensation Board, and the New York State Insurance Fund, along with various private health insurance carriers. The conviction includes charges of submission of claims for services that weren’t provided, and billing for services at a higher level than services actually performed; double-billing different programs for the same service to the same patient; and billing for services supposedly performed while he was out of the country. Dr. Langman will be sentenced in December 2011, and faces a maximum sentence of 10 years in prison.
For more information, see the full press release, here.
July 12th, 2011
On July 6, 2011, Dr. Farzad Mostashari, National Coordinator for Health IT at HHS, announced via Twitter that KPMG had been awarded a $9.2 million contract to audit compliance with the Privacy and Security Rules of HIPAA. The contract calls for as many as 150 audits of covered entities and business associates before Dec. 31, 2012. KPMG will also be creating the audit protocol.
Audits would include a site visit which would involve interviewing relevant staff, examination of operations and adherence to policies, and observation of compliance with HIPAA regulatory requirements.
More information on the details of the award and features of the audit can be found here.
July 11th, 2011
On June 30, 2011, U. S. Attorney Ripley Rand announced that Ruben and Michelle McLain of Winston-Salem were sentenced in federal court to 24 months’ incarceration and three years of supervised release for charges that include health care fraud; and they must pay over $1.3 million to the IRS to settle tax offenses. The McLains did business as Universal Services, Inc., Reynolds Home Care, and Triage Behavioral Systems, providing personal care and mental health services to Medicaid recipients. The full press release is available here.
July 8th, 2011
The AMA has published its fourth annual National Health Insurer Report Card. This report reveals that among the largest health insurers the overall rate of inaccuracy in claims payment has increased since the last report. The two percent increase over last year brings the overall processing error rate to 19.3 percent, with $17 billion in overall unnecessary administrative costs added to the health care system annually. The AMA characterizes these results as “an intolerable level of inefficiency” and calls for insurers to put more effort into paying claims correctly the first time.
UnitedHealthcare alone among the insurers included in the report reported an improvement in processing claims, with an accuracy rate of 90%. Athem Blue Cross Blue Shield scored the worst, with an accuracy rating of 61%.
The report also measures such benchmarks as non-payment or denial rates, accuracy of reporting contract fees to physicians, and response times. The National Health Insurer Report Card is part of the AMA’s Heal the Claims Process campaign, the goal of which is to encourage insurers to improve and simplify the claims submission and payment process.
The National Health Insurer Report Card along with a narrative of the Report’s highlights is available here.
A white paper outlining the AMA’s vision for administrative simplification is available on the AMA website.
June 27th, 2011
The Department of Health and Human Services Office of the Inspector General has created a webpage resource for providers and consumers regarding Quality of Care Corporate Integrity Agreements.
A Corporate Integrity Agreement (CIA) is entered into by a provider when resolving fraud allegations that may have an impact on quality of patient care. These agreements require that the provider engage an independent quality monitor. Further explanation of what it means for a provider to have entered into a CIA and to have a quality monitor is provided on the website, along with a list of press releases regarding individual providers who have entered into a CIA.
June 22nd, 2011
