Mutual Matters

Hospital Pays $42 Million to Resolve False Claims Act Allegations

Posted by Emma Cecil on Oct 12, 2017 1:00:00 PM

Los Angeles-based acute care hospital, Pacific Alliance Medical Center (PAMC), has agreed to pay $42 million to resolve whistleblower allegations that it violated the False Claims Act (“FCA”) by submitting, or causing to be submitted, false claims to Medicare and MediCal for services rendered to patients who had been referred by physicians with whom PAMC had improper financial relationships.

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Topics: Legal and Regulatory

Costly Genes: Genetic Testing and Patient Care

Posted by Marshaleen King, MD on Oct 5, 2017 12:23:00 PM

Case scenario

A 28-year-old woman presented to a primary care physician for a new patient visit. The physician conducted a fairly thorough history; however, he obtained the patient’s family history from a patient intake form, which only included questions about hypertension, heart disease and diabetes in family members. The physician neglected to ask the patient about any family history of cancer and failed to revisit her family history at any point during her subsequent follow-up visits.   

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Topics: Patient Safety

Case Study: Wrong Site Surgery

Posted by Hall B. Whitworth, Jr., MD on Oct 3, 2017 12:08:00 PM

A 49-year-old man underwent a colonoscopy by a colorectal surgeon who identified a large, firm tumor causing partial narrowing, approximately 60-70 cm from the entry site. Pathology of this tumor was suspicious for carcinoma. In addition, a polypectomy was performed at a different location, and the site was tattooed. Pathology of this second site was consistent with tubulovillous adenoma.

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Topics: Patient Safety

OIG Estimates Medicare Paid Over $700 Million in Noncompliant EHR Incentive Payments

Posted by Scott R. Grubman, Esq. on Sep 26, 2017 1:00:00 PM

Scott R. Grubman, Esq. Gregory A. Tanner, Esq. Chilivis, Cochran, Larkins & Bever, LLP

On June 7, 2017, the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services (HHS) released a report estimating that Medicare paid over $729 million in improper EHR incentive payments to healthcare providers who did not meet meaningful use requirements. 

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Topics: Legal and Regulatory

The Challenge of Noncompliance with Medical Recommendations Part 2

Posted by Hall B. Whitworth, Jr., MD on Sep 21, 2017 1:00:00 PM

 

The assessment of patient compliance is very difficult. Many patients may not want to disappoint their physician and will not be completely accurate about their degree of compliance. Other patients are not able to accurately evaluate or do not know their degree of compliance. In one study, 10% of patients reported that they were 100% compliant with their medication use. Using pill count methods, however, the use of the prescribed medications ranged from 2% to 130% of the prescribed pills.

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Topics: Legal and Regulatory

Opioids – The North Carolina STOP ACT

Posted by Blake Fagan, MD on Sep 14, 2017 12:30:00 PM

In the fight against the opioid epidemic, The North Carolina STOP Act (Strengthen Opioid Misuse Prevention) is a start.

As you may have heard, the STOP Act bill was signed into law on June 29, 2017. Here are some facts about how it will affect providers.

The following prescribing limits go into effect January 1, 2018:

  • If you are going to prescribe opioids for acute pain, you will be limited to a five-day supply or less with the initial prescription.
  • If you are going to prescribe opioids for post-operative pain, you are limited to a seven-day supply or less with the initial prescription.
  • Further opioid refills require a subsequent consultation. The provider may issue an appropriate refill with the consultation.
  • Providers should review a patient’s 12-month history in the NC Controlled Substance Reporting System (CSRS) prior to providing any opioid for pain and, if providing opioids on an ongoing basis, like for chronic pain, should review the patient’s history in the CSRS every three months thereafter. The review must be documented in the chart, or when applicable, document the technical reason that kept the provider from reviewing the CSRS.

The above rules are not required for hospice, palliative care, patients with cancer, patients in the hospital or in long-term care facilities.

So, now you know the summary of the law and how it affects us, but why did the government pass this law? Four people die every day in North Carolina from an opioid overdose. In 2015, patients in NC were dispensed 660 million opioid pills. We, as a medical community, were asked to prescribe less opioid pills. In 2016, patients in NC were dispensed 700 million opioid pills.  Furthermore, data shows that if an opioid naïve adult is prescribed a 30-day supply of an opioid prescription, he/she has a 35% chance of being on an opioid at one year and a 20% chance of being on an opioid at three years. The data shows that the increased risk of staying on an opioid starts to rise after five days of taking an opioid prescription.

To read the North Carolina Medical Board’s summary of the STOP Act, click here. To read the full text of the STOP Act, click here.

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Topics: Patient Safety

How do I know if MACRA impacts me?

Posted by Brandie Szuda on Sep 12, 2017 12:30:00 PM

Find out how MACRA will affect you and click below for more information and resources. 

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Topics: Legal and Regulatory

Hurricane checklist for your practice or hospital

Posted by Bill Kanich, MD on Sep 8, 2017 4:12:34 PM

With Hurricane Harvey’s recent devastation of the Texas gulf coast fresh in our memories, and Hurricane Irma about to make landfall in Florida, now is a good time to consider your practice’s preparation for a hurricane or any other disaster. It's not too late to prepare! While not every eventuality can be anticipated, there are a few basic steps you can take that will give your practice the best chance of returning to patient service as quickly and completely as possible after a natural disaster.

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Topics: Practice Management

Improve Collection Efforts at the Time of Service

Posted by Hoyt Torras, MPA, MHA on Sep 1, 2017 12:00:00 PM

Collecting from patients is one of the more difficult aspects of medical practice management. But few medical practices will survive without collecting a high percentage of amounts due from patients, whether they are insured or not.

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Topics: Hospital Management, Practice Management

DOJ Announces Establishment of Opioid Fraud and Abuse Detection Unit

Posted by Scott R. Grubman, Esq. on Aug 30, 2017 9:08:47 AM

Scott R. Grubman, Esq.
Gregory A. Tanner, Esq.

Chilivis, Cochran, Larkins & Bever, LLP

In response to the nationwide opioid epidemic, the U.S. Department of Justice (DOJ) has announced the creation of the Opioid Fraud and Abuse Detection Unit. 

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Topics: Legal and Regulatory

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Sharing Insight on Mutual Matters

Here we share some basic insights on matters that are important to physicians, hospitals and healthcare professionals.

Topics include:

  • MACRA
  • Legislative updates that affect healthcare professionals
  • Patient safety guidance
  • Practice and hospital management advice
  • and more.