The Department of Health and Human Services announced this morning that it has entered into a settlement agreement with Parkview Health System, Inc., an Indiana medical group caught up in HIPAA violation case. Parkview was assisting a retiring physician to transition her patients to new providers. Parkview was also considering purchasing some of the physician’s patient records. When Parkview attempted to return between 5,000 and 8,000 patient records to the physician, she was not home to accept their return. Parkview employees left cardboard boxes containing between 5,000 and 8,000 patient medical records outside of the physician’s home, and within twenty feet of a public road. In settlement and release of HHS’ claims against Parkview for such a HIPAA violation, Parkview agreed to pay the Department of Health and Human Services $800,000 and enter into a Corrective Action Plan. The entire Resolution Agreement between Parkview and HHS is available here.
New legislation placing tighter restriction on out of state M.D., D.O., and D.D.S. expert witnesses became effective July 1, 2011. HB 479 adds registration requirements for out of state or Canadian physicians wishing to serve as expert witnesses in Florida legal settings. With a $50 application fee and an application to the Florida Department of Health an expert witness will receive a certificate to provide expert testimony. The law also gives the respective boards authority to discipline, both licensed in this state and those with a certificate for providing deceptive or fraudulent expert witness testimony. Lastly, such expert witnesses who submit a pre-suit verified expert medical report no longer are immune from discipline.
It is estimated that health care fraud is a $60 billion a year business fueled by illegal conduct such submitting false claims and paying kickbacks to physicians and suppliers. Until recently, if large health care organizations were the targets of fraud investigations, these companies, as their penance, typically wrote a big check to the government and continued business as usual. Things have changed.
While indicting and convicting health care executives is not a new practice, officials at the Department of Health and Human Services (“DHHS”) and the Department of Justice (“DOJ”) are said to be frustrated with the frequent occurrence of repeat violations and they are ramping up their strategy. Lately there have been aggressive new initiatives rolling out to combat rampant health care fraud and the government is increasingly bringing criminal charges against executives even if they were not complicit in the fraud scheme, but could have stopped it if they had known.
What’s more striking is that in addition to civil monetary penalties and criminal indictments, the government is taking great efforts to exclude convicted executives from being involved in companies that do business with federal health programs. A recent bill introduced to Congress under the name of the “Strengthening Medicare Anti-Fraud Measures Act of 2011 (the “Act”), increases DHHS’ existing powers and allows them to seek to exclude owners, officers and mangers of companies that are convicted of health care fraud from federal healthcare programs even if they left the company prior to any conviction of the entity.
In addition to the expansion of the permissive exclusion afforded by the Act to DHHS, regulators and law enforcement officials are going to be increasingly utilizing current permissive exclusion remedies. DHHS’ bold move appears to be based on the rationale that the permissive authority of Secretary of DHHS or the Office of the Inspector General of DHHS to exclude individuals is a much easier process than criminal proceedings.
The impact of this aggressive new government strategy will likely have even further reaching consequences for convicted healthcare business owners and executives. For instance, an exclusion from being part of a business that works with federal health care programs would be a career ending blow for most executives. It should also be emphasized that smaller organizations are not in any way immune from enforcement activity. In fact, with newly increased enforcement budgets, authorities have the means and the time to target organizations of all sizes.
Law makers and regulators are hopeful that by ramping up the enforcement of existing laws and expanding the scope of DHHS’ power, it will act as a powerful deterrent against overt acts and will compel corporate executives to take proactive steps in preventing fraudulent activities and affirmatively addressing fraudulent practices when discovered. It is vitally important now more than ever, to have an active compliance program in place. A strong compliance program can not only detect and prevent fraudulent or negligent activities but also will typically be considered as a mitigating factor if an organization is culpable of fraudulent activity. The Florida Healthcare Law Firm works with health care organizations of all sizes to assist in the audit, development and implementation of effective compliance programs.
The advent of more entrepreneurial opportunities for physicians will cause them to wonder how to deal with Medicare patients when Medicare is the secondary payer. For instance, physicians treating Medicare patients under a Letter of Protection (LOP) need to know how to deal with the Medicare secondary payer issue.
The Department of Health and Human Services, back in 1996, issued a memorandum addressing the issues comprehensively. The memo is available on our website (www.floridahealthcarelawfirm.com), and the only piece of information missing is the requirement that Medicare claims be submitted within twelve (12) months from the date of service.