Tag Archives: medical records

How to Reconcile Integration with Anti-Kickback Laws and Market-Based Compensation

“Many hospitals are hiring and contracting with doctors to boost referrals and serve members in their coordinated-care networks. But how to pay those doctors has become a legally perilous area under the federal Stark and anti-kickback laws and the False Claims Act, with whistle-blowers, their attorneys and the Justice Department watching these transactions closely. Halifax and other recent big-dollar whistle-blower cases involving allegations that hospitals violated Stark self-referral rules in paying physicians highlight the huge stakes for hospitals, which are at risk for triple damages under the False Claims Act. Those damages are based on total billings, making the potential damages in these cases enormous.”

“The tough part for hospital leaders is that these legal pressures are at odds with public policy and market forces pushing health systems toward greater integration to improve care coordination and reduce costs. The federal government hasn’t reconciled its goal of encouraging integration with its desire to prove that it’s tough on fraud and abuse. As a result, systems pursuing integration will need to be even more vigilant because they’re stepping closer to the line where traditional Stark law enforcement might come into play.”

Read the full story here:
http://www.modernhealthcare.com/article/20140308/MAGAZINE/303089982/caught-between-competing-pressures?AllowView=VXQ0UnpwZTVDZlNXL1I3TkErT1lBajNja0U4VUNlWlZFQk1JQmc9PQ==&utm_campaign=am

Prompt Pay Laws

Many have been calling in recent days regarding insurance carriers refusing to pay for claims for treatment, essentially saying “sue us for your money.” Aside from potentially discriminatory undertones, this is patently illegal.

The State of Florida has what are known as “Prompt Pay” laws which require an insurance carrier to do just that. While I won¹t get into the details here, I thought I would share this article with you to illustrate that ³you are not alone² when it comes to this headache.

Read more about them with Law360’s article:
Hospitals Can Sue Under Prompt Pay Law: NY Appeals Court

CMS publishes final rule on direct patient access to test results

By The Pathology Blawg
The Centers for Medicare and Medicaid Services (CMS) yesterday published its final amendments to HIPAA and CLIA that will allow patients to have direct access to test results.

I talked about this back in October 2013 when HHS announced the patient access to test results final rule would be released soon.

In the broadest terms, the new rules change CLIA’s definition of “authorized person”. Until this rule, an “authorized person” was “the individual authorized under state law to order or receive test results, or both.” In many states, that meant only the physician, or other test-ordering health care provider, and not the patient.

Read the full article here