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Find out what’s happening in the world of federal healthcare regulations by reviewing some recent head-lines from across the country.
Hospital pays to resolve Stark Law allegations
To resolve allegations that it maintained improper financial arrangements with physicians, Lexington Medical Center (LMC) in West Columbia, South Carolina, has agreed to pay $ 17 million.
According to the U.S. Department of Justice, LMC allegedly entered into purchase agreements to acquire physician practices and employment agreements with 28 physicians that violated the Stark Law. The law prohibits hospitals from billing Medicare for certain services if they referred from physicians with which they have
a financial relationship. The purchase and employment agreements between LMC and the physicians allegedly took the volume and value of physician referrals into account, provided compensation above fair market value, or were not commercially reasonable.
LMC will also enter into a corporate integrity agree-ment with the Department of Health and Human Services Office of Inspector General that will require it to institute measures to avoid similar conduct in the future.
Estate of patient forcibly removed from hospital sues for wrongful death
The estate of Barbara Dawson has named Calhoun Liberty Hospital in Blountstown, Florida, as a defendant in a wrongful death lawsuit. Dawson died at the hospital in December from a blood clot in her lung after she was arrested for failing to leave after being discharged.
During the early hours of December 21, Dawson arrived by ambulance to the hospital complaining of tomach pain, according to the Tallahassee Democrat. Although she was treated, cleared to leave, and dis-charged, Dawson complained of difficulty breathing and refused to leave the hospital.
Dawson argued for more than an hour with medical staff and a Blountstown police officer called to the scene before she was placed in handcuffs and arrested for disorderly conduct and trespassing. As Dawson was being escorted out of the hospital to a police cruiser, she continued to complain of breathing difficulty and pleaded for her oxygen machine. She then collapsed and was taken back into the hospital. She died an hour later.
The Agency for Health Care Administration (AHCA) subsequently launched an investigation and found 10 deficiencies related to Dawson’s death. The AHCA fined Calhoun Liberty $ 45,000 and ordered it to undertake a corrective action plan to address the deficiencies, which included staff training on the federal requirements of the Emergency Medical Treatment and Active Labor Act
(EMTALA). EMTALA aims to prevent the practice of “patient dumping”—discharging or transferring a patient to another hospital before stabilizing treatment is provided for emergency medical conditions—by requiring hospital emergency departments that accept payments from Medicare to provide medical screening examinations (MSE) to patients seeking treatment regardless of their ability to pay, citizenship, or legal status. Among the deficiencies identified by the AHCA investigation, the hospital failed to provide Dawson an appropriate MSE when she made her complaint and discharged her without stabilizing her emergency medical condition.
Three hospital employees—two nurses and a paramedic—were also fired following Dawson’s death. The paramedic and one of the nurses have also been named as defendants in the lawsuit, along with the city of Blountstown and the arresting officer. The lawsuit alleges counts of battery, civil rights violations, and false imprisonment.
Advocate Health Care pays to settle HIPAA violations
Advocate Health Care has agreed to pay $ 5.5 million to the U.S. Department of Health and Human Services Office for Civil Rights (OCR) to settle multiple potential data protection violations of HIPAA since 2013. Advocate will also adopt a corrective action plan.
The OCR began investigating Advocate, an Illinois-based health system with more than 250 treatment
locations and 10 hospitals, three years ago after the health system submitted three breach notification reports that, combined, affected the electronic protected health information (ePHI) of about 4 million patients. The ePHI included patient names, birthdates, addresses, credit card numbers, and clinical information.
The investigation found several failures by Advocate to secure ePHI, including failure to conduct an accurate and exhaustive assessment of potential risks and vulnerabilities and implementing policies and procedures, as well as a lack of facility access controls to limit physical access to electronic information systems housed within its data support center.
Tenet Healthcare pays to settle kickback allegations
To resolve a whistleblower lawsuit that alleged it paid illegal kickbacks in exchange for maternity referrals to four of its hospitals, Tenet Healthcare has agreed to pay the U.S. government $ 514 million.
The lawsuit alleged that four hospitals—Atlanta Medical Center; North Fulton Regional Hospital in Roswell, Georgia; Spalding Regional Hospital in Griffin, Georgia; and Hilton Head Hospital in Hilton Head Island, South Carolina—paid kickbacks to Clinica de la Mama for Medicaid patient referrals in violation of the federal anti-kick-back statute. The kickbacks were disguised as payments for services provided by Clinica de la Mama, which operated medical clinics that provided prenatal care to primarily undocumented Hispanic women. In return, Clinica de la Mama would refer pregnant women to the hospitals for their deliveries. Tenet has since sold Atlanta Medical Center, North Fulton Hospital, and Spalding Regional Hospital.
As part of the settlement, two of Tenet’s subsidiaries that had operated Atlanta Medical Center and North Fulton Hospital will also plead guilty to one count of conspiracy to violate the federal anti-kickback statute and defraud the United States. Tenet will also appoint a corporate monitor for three years as a condition of the settlement.
A related lawsuit was also recently settled when Health Management Associates (HMA) and Clearview Regional Medical Center in Monroe, Georgia, agreed to pay nearly $ 600,000. The lawsuit alleged that from 2008 to 2009, Clearview—then known as Walton Regional Medical Center—also paid kickbacks to Clinica de la Mama in exchange for patient referrals.
In announcing the settlement, Derrick L. Jackson, special agent in charge from the U.S. Department of Health and Human Services’ Office of Inspector General’s Atlanta Regional Office said, “Hospitals that pay kickbacks to clinics for referrals of undocumented pregnant patients are taking advantage of both these vulnerable women and the taxpayer-funded Medicaid program … Our agency is dedicated to investigating such corrosive kickback schemes, which undermine the public’s trust in medical institutions and the financial health of government health care programs.”
Stolen laptop triggers HIPAA breach notification, investigation
The University of Mississippi Medical Center (UMMC) will pay $ 2.75 million to settle alleged HIPAA violations uncovered by an OCR investigation. UMMC will also be required to adopt a corrective action plan to help avoid future violations.
In March 2013, UMMC notified OCR of a breach after a visitor stole a password-protected laptop from its medical ICU. OCR investigation found ePHI on UMMC’s network drive could be accessed without authorization through its wireless network, exposing a directory of 67,000 files; 328 of those files contained ePHI of approximately 10,000 patients. The investigation found that UMMC was aware of its system’s vulnerabilities eight years before the breach but did not undertake any significant risk management activities. Organizational deficiencies and insufficient institutional oversight were to blame.
The OCR investigation found that UMMC failed to secure ePHI by not implementing policies and procedures that would prevent, identify, contain, or correct security violations; restrict unauthorized access to ePHI by safe-guarding workstations; and notify the individuals whose ePHI was believed to have been accessed by the breach.
Find out what’s happening in the world of federal healthcare regulations by reviewing some recent headlines from across the country.
EMTALA violations declining
The number of U.S. hospitals cited for violating the Emergency Medical Treatment and Active Labor Act (EMTALA) has decreased over a 10-year period, according to a study published in the Annals of Emergency Medicine. Researchers analyzed a list from CMS of EMTALA investigations conducted from 2005?2014 and found that the percentage of U.S. hospitals cited for violations citations decreased from 5.3% to 3.2%. The percentage of hospitals investigated also declined during this period from 10.8% to 7.2%.
EMTALA aims to prevent the practice of discharging or transferring patients to other hospitals before stabilizing treatment is provided for emergency medical conditions. It requires hospital emergency departments to provide medical screening examinations to patients seeking medical treatment regardless of their ability to pay, citizenship, or legal status.
Stark Law, EMTALA violation penalty amounts increase
Due to several years of inflation, the U.S. Department of Health and Human Services recently issued an interim final rule that calls for steeper maximum penalties for violating federal regulations, including EMTALA and the Stark Law.
For hospitals with more than 100 beds, the maximum penalty for an EMTALA violation is $ 103,139, up from the previous maximum of $ 50,000 set in 1987. For hospitals with less than 100 beds, the maximum penalty is $ 51,570, up from $ 25,000.
Circumventing the Stark Law’s self-referral restriction can now result in a maximum penalty of more than $ 159,000, up from previous maximum of $ 100,000 set in 1994. Submitting claims in violation of the Stark Law can result in a penalty of nearly $ 24,000, up from $ 15,000.
Home health agency owner sentenced for healthcare fraud, kickbacks
Khaled Elbeblawy, the former owner and manager of three home health agencies in the Miami area, will spend 20 years in prison for his role in a scheme that fraudulently billed Medicare for millions of dollars.
Elbeblawy was sentenced to prison and ordered to pay more than $ 36 million in restitutions following his conviction in January of one count of conspiracy to commit healthcare fraud and wire fraud and one count of conspiracy to defraud the United States and pay healthcare kickbacks. According to evidence presented at trial, from 2006?2013, Elbeblawy and his co-conspirators claimed to have provided medically necessary home health services to Medicare beneficiaries through the three agencies: Willsand Home Health Agency Inc., JEM Home Health Care LLC, and Healthy Choice Home Services Inc. In reality, those services were either medically unnecessary or never provided. The conspirators also paid kickbacks to physicians, patient recruiters, and staffing groups for referrals of beneficiaries.
In all, Elbeblawy and his co-conspirators submitted $ 57 million in false or fraudulent claims and received approximately $ 40 million in payments. In 2012, Eulises Escalona, a former owner of Willsand and JEM, pled guilty to one count of conspiracy to commit healthcare fraud and was sentenced to 10 years in prison. Cynthia Vilches, former co-owner of Healthy Choice, also pled guilty to one count of conspiracy to commit healthcare fraud and is awaiting sentencing.
Healthcare systems calls for dismissal of antitrust lawsuit
Carolinas HealthCare System (CHS) has argued that the joint antitrust lawsuit filed against it by the U.S. Justice Department and the North Carolina Attorney General’s office has no basis. According to the Charlotte Observer, the lawsuit alleges CHS uses its size to drive up prices to prevent competition. CHS operates 10 hospitals in the Charlotte area. Its closest competitor, Novant Health, operates five.
The lawsuit alleges CHS uses its clout to encourage health insurers to steer patients away from other lower-priced hospitals and toward CHS hospitals.
In asking for a dismissal, CHS has said the lawsuit has failed to allege any actual competitive harm to the marketplace.
Regulatory requirements are likely to be an important aspect of physician dissatisfaction with electronic health records (EHRs) that is driving burnout, according to an Ideas and Opinions piece published online May 8 in the Annals of Internal Medicine.
The post Regulatory Requirements Drive Dissatisfaction With EHRs appeared first on The Coding Network.
Legal and regulatory news roundup
Find out what’s happening in the world of federal healthcare regulations by reviewing some recent headlines from across the country.
Senate Finance Committee aims to reform Stark Law
The Senate Finance Committee hopes to introduce legislation to reform the federal physician self-referral law, commonly referred to as the Stark Law. During a recent hearing, Chairman Orrin Hatch (R-Utah) said the committee would take some action by the end of 2016 but did not elaborate on what that might be.
In June, Hatch released a white paper discussing potential reforms to the Stark Law. Several commenters suggested repealing the law in its entirety. Others suggested changes to the law that would allow providers to implement new payment models.
In a statement released with the white paper, Hatch said the Stark Law is "a real burden for hospitals and doctors trying to find new ways to provide high quality care while reducing costs as they work to implement recent healthcare reforms."
Hundreds charged with healthcare fraud in nationwide sweep
More than 300 physicians, nurses, and other medical professionals across the country allegedly involved in healthcare fraud schemes face criminal and civil charges following what the U.S. Department of Justice called the largest coordinated takedown in history. The Medicare Fraud Strike Force in 36 federal districts led the sweep, which also involved 23 state Medicaid Fraud Control Units and 26 U.S. Attorney’s Offices.
The individuals charged are suspected of collectively submitting approximately $ 900 million in fraudulent billing to Medicare and Medicaid. They face multiple healthcare fraud-related charges, including conspiracy to commit healthcare fraud, aggravated identity theft, money laundering, and violations of the anti-kickback laws for schemes in which they submitted claims for medically unnecessary treatments. Often the treatments were never provided. In some cases kickbacks were paid to Medicare beneficiaries, patient recruiters, and other co-conspirators in return for providing beneficiary information to providers to use in submitting fraudulent billing.
Some of the highlights of the sweep include:
In an announcement of the arrests, Attorney General Loretta E. Lynch said, "The wrongdoers that we pursue in these operations seek to use public funds for private enrichment. They target real people?many of them in need of significant medical care. They promise effective cures and therapies, but they provide none. Above all, they abuse basic bonds of trust?between doctor and patient; between pharmacist and doctor; between taxpayer and government?and pervert them to their own ends."
Cardiologist agrees to pay $ 2 million to settle kickback, false billing lawsuit
Asad Qamar, MD, of the Institute of Cardiovascular Excellence (ICE) of Ocala, Florida, has agreed to pay $ 2 million to resolve a lawsuit alleging he paid kickbacks to patients and improperly billed Medicare, Medicaid, and TRICARE?a healthcare program of the U.S. Department of Defense Military Health System. Qamar will also release any claim to $ 5.3 million in suspended Medicare funds and agreed to a three-year exclusion from participating in any federal healthcare program. This will be followed by a three-year integrity agreement with the Department of Health and Human Services Office of the Inspector General.
According to the U.S. Department of Justice, the lawsuit against Qamar claimed that he and ICE billed for peripheral artery interventional services and other related procedures, many of which were medically unnecessary according to the patients’ medical histories or records, or by the severity of their symptoms.
The lawsuit also alleged that Qamar and ICE persuaded patients to agree to the unnecessary procedures by routinely and indiscriminately waiving the 20% Medicare copayment. The copayment is typically used to help patients be smarter healthcare consumers and deter them from unnecessary procedures.
According to The Wall Street Journal, following a legal effort by the paper, CMS made public Medicare payment data which showed that Qamar had collected more than $ 18 million from Medicare in 2012. That ranked him second highest paid among all physicians in the country and four times more than the third highest paid cardiologist.
The settlement resolves two consolidated lawsuits originally filed under the whistleblower provision of the False Claims Act. The two individuals who originally brought the suit will receive about $ 1.3 million for their share of the settlement.
Former Warner Chilcott president acquitted on anti-kickback charge
W. Carl Reichel, former president of Warner Chilcott, was found not guilty of conspiring to pay kickbacks to physicians to induce them to prescribe its drugs.
The government’s case against Reichel alleged that he encouraged members of the sales force to provide physicians with payments, meals, and other rewards. According to court documents, Reichel was acquitted on grounds that there wasn’t insufficient evidence to suggest that he had ever given the sales team any such direction.
Last October Warner Chilcott agreed to plead guilty before a federal judge in U.S. District Court for the District of Massachusetts to a felony healthcare fraud charge and pay $ 125 million to settle criminal and civil liability related to illegal marketing of several of its drugs. This included paying kickbacks to physicians throughout the country to encourage them to prescribe their drugs.
Legal and regulatory news roundup
Find out what’s happening in the world of federal healthcare regulations by reviewing some recent headlines from across the country.
Legislation introduced to stop Stark Law loophole
A bill introduced in Congress seeks to close a loophole in the Stark Law that allows physicians to self-refer patients for certain services that they have a financial interest in and that they provide in their offices. The Promoting Integrity in Medicare Act (PIMA), also known as H.R. 5088, aims to prevent harmful and wasteful Medicare spending by prohibiting self-referrals for the following four services: advanced diagnostic imaging, anatomic pathology, radiation oncology, and physical therapy.
Under the Stark Law, physicians are banned from referring Medicare patients for healthcare services in which they have a financial interest. However, the law includes an exception for in-office ancillary services, which are those that are can be provided at the time of a patient’s initial visit. The four services targeted by PIMA are typically not performed the same day.
According to the Congressional Budget Office, closing the loophole on the four services could save an estimated $ 3.3 billion over 10 years.
"How many [U.S. Government Accountability Office] studies outlining the abuse and billions of dollars of Medicare reimbursement to doctors for unnecessary services that are driven purely for personal profit does it take to shut this activity down?" said Rep. Jackie Speier, the bill’s sponsor, in a statement. "This is a golden opportunity to put patient health and program health over profits."
The bill has been referred to the Committee on Energy and Commerce and the Committee on Ways and Means.
Healthcare product manufacturer, supplier pay to settle kickback allegations
To resolve allegations that it paid unlawful kickbacks to a medical products supplier, Hollister, Inc., has agreed to pay $ 11.4 million. In turn, the medical products supplier Byram Healthcare Centers, Inc., has agreed to pay $ 9.3 million to settle allegations of receiving the kickbacks.
According to the U.S. Department of Justice, from 2007 to 2014, Hollister, which manufactures disposable healthcare products, allegedly paid Byram kickbacks in return for marketing promotions, conversion campaigns, and other patient referrals to its products. Several times throughout the years, Hollister allegedly paid Byram’s costs for bonus commission paid to its sales personnel for new patient orders of Hollister products. Hollister also allegedly paid Byram $ 200,000 every year from 2009 to 2014 for "catalog funding," which instead was used to generate recommendations of its products to Byram’s patients.
Byram’s settlement payment resolves allegations it received kickback payments from Hollister and three other manufacturers?Coloplast Corp., Montreal Ostomy, and Safe N’ Simple?in exchange for promotional campaigns and patient referrals to their products.
As part of the settlement, Byram must also pay $ 127,000 to California to resolve allegations it submitted falsely inflated claims to the state’s Medicaid program, Medi-Cal. Byram allegedly failed to account for substantial discounts it received for products when it billed Medi-Cal for products sold to Medi-Cal beneficiaries.
Of the settlements, U.S. Attorney Carmen M. Ortiz, for the District of Massachusetts, said, "We are committed to rooting out commercial bribery, especially in the healthcare industry where the payment of kickbacks erodes patients’ trust in the quality of their medical care … These unlawful cash incentives also threaten the integrity of the healthcare system and siphon taxpayer dollars from our nation’s healthcare programs."
The settlements also resolved a whistleblower lawsuit filed by one current and two former Coloplast employees. A provision of the False Claims Act allows whistleblowers a share in any recovery. The whistleblowers’ share of the settlement has not yet been determined.
ACLU launches campaign over alleged EMTALA violations
The American Civil Liberties Union (ACLU) and MergerWatch recently released a report to bring attention to what they believe is the practice among Catholic hospitals of denying emergency reproductive healthcare on religious grounds.
The report takes issue with Catholic hospitals’ partial or full adherence to Ethical and Religious Directives for Catholic Healthcare Services, a set of policies issued by the U.S. Conference of Catholic Bishops. The ACLU claims that implementation of these directives has led to instances in which pregnant patients are denied care, which is a violation of the Emergency Medical Treatment & Active Labor Act of 1986 (EMTALA).
EMTALA requires hospitals that receive Medicare funds to provide medical screening exams to patients who arrive at their emergency departments and appear to need emergency medical services. These screenings must be conducted by a qualified medical staff professional to determine whether a patient has an emergency condition. If so, the patient must be provided stabilizing treatment.
The report collects accounts of patients suffering miscarriages who were denied reproductive health services, such as emergency abortions or tubal ligations, even when their own health was at risk, due to the directives.
The report recommends that CMS issue a statement emphasizing that denial of emergency reproductive healthcare violates EMTALA, regardless of religious affiliation. It also calls for CMS to investigate any alleged violations and take corrective actions when necessary.
A statement released by the Catholic Health Association denounces the ACLU-MergerWatch report and states, "To frighten families with scary, one-sided stories and exaggerated data is grossly disrespectful to the thousands of physicians, midwives and nurses working in Catholic hospitals who are so devoted to their patients and to the care they deliver."
The statement adds that allegations made in the report are unsubstantiated and that some have been subject to lawsuits that have been dismissed by the courts. It also defends the Ethical and Religious Directives for Catholic Healthcare Services as guidelines consistent with the delivery of safe and effective patient care.
Healthcare company owner convicted on kickback charges
A New Orleans jury convicted Tracy Richardson Brown, owner and operator of Psalms 23 DME, LLC, for directing a scheme that billed Medicare $ 3.9 million for often fraudulent claims. Brown was convicted on nine counts of healthcare fraud, seven counts of paying illegal kickbacks, one count of conspiracy to commit healthcare fraud, and one count of conspiracy to pay illegal kickbacks.
According to evidence introduced at trial, Brown paid patient recruiters for the information of Medicare recipients in the New Orleans area. Her company then used names and Medicare numbers to bill Medicare for medical equipment that was not needed, such as power wheelchairs and orthotics. Often the equipment was not even provided to the patients. Brown also billed Medicare for high-cost back and knee braces, when in reality she provided patients with much cheaper versions. In all, Medicare paid Brown $ 1.9 million for her fraudulent claims.
Brown’s sentencing hearing is scheduled for August 10.
Physician sentenced to nine years in prison for fraud scheme
A Miami physician who admitted to his role in a Medicare fraud scheme has been sentenced to 108 months in prison and ordered to pay more than $ 30 million in restitutions.
In February, Henry Lora, the former medical director of Miami-based clinic Merfi Corporation, pleaded guilty to one count of conspiracy to commit healthcare fraud and one count of conspiracy to defraud the United States, receive healthcare kickbacks, and make false statements relating to healthcare matters.
As part of a plea deal with prosecutors, Lora admitted he and his co-conspirators wrote prescriptions for home health care and other services for Medicare beneficiaries that were not medically necessary or provided in exchange for bribes and kickbacks from multiple home healthcare agencies in the Miami-Dade area. He also admitted to falsifying patient records so that it appeared beneficiaries qualified for the services.
Legal and regulatory news roundup
Find out what’s happening in the world of federal healthcare regulations by reviewing some recent headlines from across the country.
Hospital’s EMTALA violations threaten its federal funding
CMS has threatened to cut Medicare and Medicaid funding for Indian Health Service’s (IHS) Sioux San Hospital in Rapid City, South Dakota, after an unannounced inspection in May found deficiencies in the emergency department.
According to the CMS report, the hospital failed to provide patients with timely medical screening examinations to determine whether they had an emergency medical condition, which is a violation of the Emergency Medical Treatment and Active Labor Act of 1986 (EMTALA). CMS based its findings on a review of medical records and interviews with patients, patient representatives, and hospital staff.
A case cited in the CMS report recounts how a mother brought her 6-month-old baby to the emergency department at Sioux San complaining of congestion, cough, runny nose, and watery eyes. The attending provider diagnosed the baby with a viral respiratory infection without taking a patient history, which would have revealed that the baby was born premature and had a history of respiratory distress. The baby later had a seizure and spent time in the ICU at another facility.
Shortly after the inspection, CMS informed IHS that it had until June 15 to address the deficiencies or risk losing Medicare and Medicaid reimbursements. IHS has submitted a 31-point correction action plan, which CMS has accepted.
The corrective plan includes:
Three defendants plead guilty in $ 580 million fraud, kickback case
The U.S. government’s ongoing investigation into kickbacks paid for patient referrals and fraudulent billing at Pacific Hospital in Long Beach, California, has led to three more defendants pleading guilty to federal charges. They join six other individuals who have already pleaded guilty to charges of participating in a 15-year-long scheme that illegally referred thousands of patients to the hospital and generated hundreds of millions in fraudulent billings.
The investigation is looking into allegations that dozens of surgeons and other medical professionals participated in a scheme with Pacific Hospital in which they were paid kickbacks for referring patients to the hospital for spinal surgeries. Members of the conspiracy were paid $ 15,000 for every lumbar fusion surgery and $ 10,000 for every cervical fusion surgery referred to Pacific Hospital. During the last eight years of the scheme, Pacific Hospital submitted more than $ 580 million in bills for spinal surgeries, many of which were paid by the federal workers’ compensation system and the California workers’ compensation system.
The latest defendants to plead guilty are Michael Drobot Jr., Linda Martin, and Michael Barri.
Drobot Jr. pleaded guilty to charges of conspiracy and illegal kickback charges and faces up to 10 years in prison. He is the son of Michael Drobot Sr., the owner of Pacific Hospital who previously pleaded guilty to orchestrating the scheme in April 2014. Drobot Jr. solicited physicians and chiropractors to enter into the kickback arrangements with the hospital and served as a liaison with medical professionals.
Martin, a marketer for Pacific Hospital, also pleaded guilty to a conspiracy charge for recruiting medical professionals to refer patients to the hospital in exchange for kickbacks. She could be sentenced to up to five years in prison for her charge.
Barri, a chiropractor, pleaded guilty to a conspiracy count and admitted he received more than $ 158,000 in kickbacks during a nine-month period for referring dozens of patients to Pacific Hospital. Pacific Hospital used Barri’s referrals to bill insurance carriers $ 3.9 million for spinal surgeries. He faces up to five years in prison.
Drobot Jr., Martin, and Barri, along with the previous six defendants, have agreed to cooperate with the ongoing investigation being conducted by the FBI, the U.S. Postal Service Office of Inspector General, IRS Criminal Investigation, and the California Department of Insurance.
Healthcare providers responding to online reviews may violate HIPAA
A report from ProPublica has found that some healthcare providers apparently violate HIPAA when replying to reviews on the rating website Yelp. After analyzing more than 1.7 million reviews on the website, ProPublica found that some physicians, dentists, and chiropractors shared patient health information when responding to online criticism from patients.
ProPublica identified more than 3,500 one-star reviews on Yelp that mentioned privacy and HIPAA. The report further details several instances of HIPAA violations, which have resulted in warnings from the U.S. Department of Health and Human Services’ Office for Civil Rights as well as ongoing investigations after the patients filed complaints. The Office for Civil Rights, however, does not track how many complaints it has received regarding HIPAA violations on Yelp.
ProPublica was able to speak to some patients who claim their personal information was disclosed by providers on Yelp. They said the violation of their medical privacy only compounded the damage they received from poor care.
Physician indicted on kickback charges
A federal grand jury has indicted Hailu T. Kabtimer, MD, of Henderson, Tennessee, with five counts of violating the federal anti-kickback act.
According to the U.S. Attorney’s Office for the Middle District of Tennessee, from 2013 to 2014, Kabtimer allegedly accepted cash payments in exchange for patients to a particular medical equipment supplier.
During that time, the indictments alleged Kabtimer allegedly accepted kickback payments on eight occasions, totaling $ 3,400. Additionally, Kabtimer allegedly accepted $ 200 for every patient he referred for a continuous positive airway pressure ventilator and $ 300 for every patient he referred for an oxygen unit.
In a statement, U.S. Attorney David Rivera said, "Medical providers who break the law to enrich themselves will be caught and prosecuted … This office and our law enforcement partners will continue our vigorous efforts to enforce the anti-kickback law and to hold accountable medical professionals who accept illegal cash kickbacks."
If found guilty, Kabtimer faces up to five years in prison for each count. He would also face forfeiture of any proceeds traced back to offenses.
Data breach compromises 4,000 patients’ protected health information
More than 4,000 patients of Complete Chiropractic & Bodywork Therapies (CCBT) of Ann Arbor, Michigan, were recently notified of a breach that may have been exposed their treatment and billing information. This includes patients’ encrypted electronic medical record data, such as their names, dates of birth, addresses, Social Security numbers, and health/diagnosis information.
CCBT reported the breach after discovering a server infected with malware. The server was immediately secured and disconnected from the internet; all workstation and vendor passwords were changed, and additional IT security safeguards were put in place, according to a statement released by CCBT.
An investigation determined that the malware was likely scanning for login and password information and that the first unauthorized access occurred four months prior to the breach’s discovery. However, CCBT noted that there was no indication that any patient information had been taken or inappropriately used.
CCBT has offered all affected patients a free year of identity theft protection.
Patient recruiter sentenced for Medicare fraud, kickback scheme
Carlos Rodriguez Nerey, owner and president of Nerey Professional Services, Inc., a Miami-based consulting and staffing company, will spend five years in prison for his role in a $ 2.3 million Medicare fraud scheme.
In April, following a one-week jury trial, Nerey was convicted of one count of conspiracy to defraud the United States and pay and receive healthcare kickbacks, and one count of receiving healthcare kickbacks. At Nerey’s recent sentencing, U.S. District Judge Darrin P. Gayles of the Southern District of Florida imposed the prison term and ordered that Nerey pay $ 2.3 million in restitutions.
From October 2014 to September 2015, Nerey would accept kickbacks from Miami-based healthcare agencies Mercy Home Care, Inc., and D&D&D Home Health Care, Inc., in exchange for referring Medicare beneficiaries to serve as patients. Some patients didn’t actually qualify for home healthcare services based on Medicare’s rules and regulations. Nerey’s actions contributed to the submission and subsequent payment of millions of dollars in fraudulent claims to Medicare.
According to evidence presented at trial, Nerey created a shell company to accept approximately $ 250,000 in kickbacks from the two home healthcare agencies. He had also previously worked for several other fraudulent home healthcare agencies in the area.