Archive for the Medicolegal Category

Could failing to get health insurance make you a prisoner?

Posted in Health Care Policy, Medicolegal with tags , , on November 7, 2009 by drbobbs

ThePrisonerAccording to Michigan Republican Representative David Camp, the answer is yes:

When confronted with this same issue during its consideration of a similar individual mandate tax, the Senate Finance Committee worked on a bipartisan basis to include language in its bill that shielded Americans from civil and criminal penalties. The Pelosi bill, however, contains no similar language protecting American citizens from civil and criminal tax penalties that could include a $250,000 fine and five years in jail.

“The Senate Finance Committee had the good sense to eliminate the extreme penalty of incarceration. Speaker Pelosi’s decision to leave in the jail time provision is a threat to every family who cannot afford the $15,000 premium her plan creates.

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Obamacare dead for 2009?

Posted in Economics of Health Care, Health Care Policy, Medicolegal with tags , , on November 3, 2009 by drbobbs

Is Obamacare, for the present at least, dead on arrival?  According to ABC News, it is:

Senior Congressional Democrats told ABC News today it is highly unlikely that a health care reform bill will be completed this year, just a week after President Barack Obama declared he was “absolutely confident” he’ll be able to sign one by then.

“Getting this done by the by the end of the year is a no-go,” a senior Democratic leadership aide told ABC News. Two other key Congressional Democrats also told ABC News the same thing.

This administration seems to have been totally unprepared for the resistance to their proposed health care reforms.  The town halls of this past summer will go down in American political history as the model of how not to sell an idea to the American people.  And the series of health care reform bills, culminating most recently in a 1,990 page behemoth that “runs more pages than War and Peace [and] has nearly five times as many words as the Torah,” are bloated and bureaucratic.  The $1.2 trillion price tag does little to inspire confidence that health care costs will in any way be lowered by it.

Of course, we don’t really seem to inclined to lower health care costs in the United States anyway.  Are fast food restaurants going out of business due to a lack of customers?  Is there a public outcry for loser pays medical malpractice reform?  Is there bipartisan support to allow individuals and groups to purchase health insurance across states lines to create a truly national health insurance market with competition and lower prices?  Are there any substantive steps to increase the number of primary care physicians in the country?

So far, the answer across the board appears to be “No.”

Why Trial Lawyers Will Love Democrat Health Reform Bill

Posted in Health Care Policy, Medicolegal with tags , , on October 31, 2009 by drbobbs

Andrew Breitbart’s Big Government website reports that the Pelosi Health Care Bill Blows a Kiss to Trial Lawyers:

Section 2531, entitled “Medical Liability Alternatives,” establishes an incentive program for states to adopt and implement alternatives to medical liability litigation. [But]…… a state is not eligible for the incentive payments if that state puts a law on the books that limits attorneys’ fees or imposes caps on damages.

I guess I’ve got a different definition for “incentive”.

Red flag implementation delayed (again)

Posted in Medicolegal, Practice Management with tags , , , on July 31, 2009 by drbobbs

redflagThe Federal Trade Commission (FTC) has delayed the enforcement date of the so-called Red Flag Rules regarding identity theft protocols for medical practice.  November 1, 2009 is the latest revised target date by which medical offices must comply with the rules.

Just a reminder: the American Academy of Family Physicians (AAFP) has a link to help offices navigate this process, as well as a Microsoft Word format, one-page, ready-made Red Flag protocol.

Identity Theft Red Flags Rule Delayed

Posted in Health Care Policy, Medicolegal, Practice Management with tags , , , on May 5, 2009 by drbobbs

agentsmithThe Federal Trade Commission has decided to allow medical practices until August 1st, rather than the original target date of May 1st, to implement identity theft prevention programs, according to AAFP News Now.  At least the creep of government overregulation of medicine has been slowed a bit.  Better than nothing, but not by much.

Identity theft and medical practices

Posted in Medicolegal, Practice Management with tags , , , on April 16, 2009 by drbobbs

Identity theftEffective May 1st, medical offices will be required to have in place an identity theft prevention program.  Is there really any reason for having this?  No.  There was also never a plague of patient confidentiality violations, but that didn’t stop HIPAA.  When the government has a solution, little details like the non-existence of the problem are simply ignored.

Fortunately, the American Academy of Family Physicians has resources in place to help medical offices deal with this latest (but by no stretch of the imagination last) unnecessary bureacratic intrusion into the art and science of medicine.  This link to the AAFP’s Identity Theft Red Flags Rule page is a good place to start.  The “meat and potatoes” of this nonsense can be found here.  To really get to the bottom line, the AAFP has developed this one page Red Flag Rule table in Microsoft Word format that can be downloaded and printed and will probably answer as a serviceable plan for most practices.

Is this company trying to extort money from doctors?

Posted in Medicolegal with tags , , , , on April 13, 2009 by drbobbs

Here is a story  from American Medical News about a company that is sending out letters requesting repayment for “overpaid” claims, many of them several years old:

When Snellville, Ga., internist Joel Fine, MD, read a note from a company called Health Research Insights, he thought it sounded a little bit like a chain letter — vaguely threatening, insistent on a quick response, with few details.

The letter, addressed “Dear Health Care Professional,” accused Dr. Fine of upcoding four claims for treating Georgia-Pacific employees. The earliest dated back to February 2005. “Of course, I was offended,” Dr. Fine said.

HRI’s letter offered him two choices: pay $347 to “immediately settle this issue” or send complete records proving he did not incorrectly bill for the visits in question. The letter warned that if Dr. Fine did not pay HRI or contact them with records to prove his innocence, his case could be turned over to federal authorities.

Since late last year, thousands of doctors in Georgia and Tennessee have received letters from HRI similar to Dr. Fine’s. The Indiana State Medical Assn. says it has received a warning from HRI that it will start collection efforts in that state.

Like health plans, HRI identifies physicians it believes are above the norm in the number of high-level codes they submit and targets them for recoupments. Unlike health plans, however, HRI does not analyze individual medical records along with the claims.

It uses, by the company’s own description, an algorithm to determine the amount of upcoding and overpayment — then demands that the physicians produce the medical records and other paperwork to fight the claim.

HRI’s chief executive officer, Theodore Perry, PhD, wouldn’t talk to American Medical News. But the company’s Web page describes its business as authorized under ERISA.

Health care attorneys and experts in ERISA law said doctors who receive the type of letter Dr. Fine received from HRI should think twice before just sending a check.

“The reality is you don’t even have to talk with these people,” said Michael F. Schaff, an attorney who specializes in health care and contracting with the firm Wilentz, Goldman & Spitzer in Woodbridge, N.J.

“Until they show they have some type of authority, they’re bluffing,” he said. “This comes out of the blue saying, ‘You owe us X amount of dollars.’ To me, that’s extortion.”

Both Blue Cross Blue Shield of Tennessee and Blue Cross Blue Shield of Georgia have sent out letters denying any complicity with HRI’s attempts at getting money from physicians.  So who and what are Health Research Insights, Inc.?  According to their website, Theodore L. Perry, Ph.D., Johnny E. Gore, M.D., and Charles L. Polatsek, M.B.A. are the company’s “founding partners.”  According to this website, they are also the entire company.  The HRI website lists the following address and phone number:

Health Research Insights, Inc.
P.O. Box 682467
Franklin, TN, 37068-2467
Recovery 615-916-4480

The MANTA website has other contact information:

Health Research Insights, Inc
381 Riverside Dr, Ste 300
Franklin, TN 37064-8934
Contact Phone: 615-224-0240

This website has yet another address and a fax number:

Health Research Insights, Inc.
1120 Holiday CT, Ste 4
Franklin, TN 37067-1302
Phone 615-224-0240
Fax 615-224-0241

The fax number given to Dr. Fine in the letter he received from HRI was 615-263-0196.

The Tennessee Medical Association (link requires TMA member log in) warns: “The TMA Legal Department says letters from Health Research Insights (HRI) demanding overpayment recoupment may not be based on prior review of clinical records.”