The OIG Addresses Free Patient Transportation Issues

vanBy: Jacqueline Bain

The issue of whether a medical provider can provide free patient transport is one that we are asked to look into a few times every year. Aside from the liability issues that it raises, it is one that we have never been able to justify from an Anti-Kickback and Patient Brokering perspective.  The fact is, even given the good intentions of most providers to allow their patients easier access to healthcare, transporting patients to and from your facility or practice is providing them with something of value in return for coming to see you.  However, under slightly different facts than we are usually asked to consider the question, last week, the Department of Health and Human Services Office of the Inspector General (“OIG”) came to a different conclusion.

The OIG issued an advisory opinion upon the request of a hospital system who had asked whether it could provide free transportation to persons who had limited access to public transportation to access the hospital’s facilities. The hospital system offered that the town had inadequate and infrequent public transportation services which would act as a barrier to healthcare for local residents.  The hospital system offered the following facts for consideration:Continue reading

Cigna Points to Tox Costs and Fraud in Quitting Florida Obamacare

gavelBy: Jeff Cohen 

Cigna just announced it is withdrawing from Florida’s Health Insurance Marketplace.  As reported by Carol Gentry in Health News Florida, Cigna blamed its decision to withdraw on fraud and abuse and on “out of network substance abuse clinics and labs.”  Interestingly, Cigna spokesman, Joseph Mondy, pointed to a recent article in the Palm Beach Post (“Addiction Treatment Bonanza:  How urine tests rake in millions”) in support of Cigna’s announcement.

Media reports regarding the treatment industry and Cigna’s announcement go unquestioned by reporters.  For instance, the Palm Beach Post article claims “the sky-high charges have exploited addicts and alcoholics seeking help, gouged insurers and spurred law enforcement interest….”  It pictures a young, tattooed man as a recovery business owner, but does not mention any wrongdoing or charges against him.  It restates claims in a lawsuit against a toxicology lab without any counterbalancing input from the lab that is the subject of the lawsuit.  It expresses certainty that insurers are being gouged, but does not mention that the rates actually paid by insurers for out of network services are determined entirely by the insurers, not the treatment providers.  It’s an article full of allegations and innuendos, but no meaningful coverage of any of the issues.     Continue reading

Liability Trends in the Delivery of Addiction Treatment

300x300_alertBy: Tom Murphy, Guest Contributor

Behavioral healthcare, and specifically addiction treatment, is rapidly growing and changing as the United States tries to move away from the failed “war on drugs” to the “demand reduction” model. Additionally, the Affordable Care Act has not only increased the number of insured patients seeking care, it has managed to bring behavioral healthcare front and center in the debate on the demand for behavioral health and recovery treatment.

Along with the increase in the patient base and various methods of available treatment, there is an upward trend in the frequency and indemnity payments for professional liability claims in behavioral healthcare and addiction treatment. Typical allegations involve mismanagement or misapplication of suicide-risk information, improper prescribing or management of medications, as well as other errors and omissions involving care. Sexual misconduct is another area of concern that can lead to large settlements by either the provider or the professional liability carrier. Carriers are also starting to see an increase in general liability claims related to facility amenities such as swimming pools. General agents who are not familiar or experienced with recovery clients are not properly insuring many of these exposures. You should always review your professional and general liability coverage with an experienced behavioral healthcare and recovery insurance specialist.Continue reading

Recent Governmental Enforcement and Regulatory Developments

Headshot - DDBy: Dave Davidson

The last few weeks have seen some significant examples of the federal government’s vigilance in policing the healthcare market.  These events serve as a reminder of the highly regulated and scrutinized industry in which we work.  They are also a reminder to physicians and other providers to make sure their practices and contractual arrangements can pass this scrutiny.

The most significant recent event is the $115 million settlement between the government and the Adventist Health System.  This settlement resolved two whistleblower cases brought against the system by three employees.  The lawsuits alleged that the Adventist Health System violated the Stark law, which generally prohibits payments to physicians for making referrals unless an exception to the law is met.  The specific allegations against the Adventist Health System were that the compensation paid by the health system to some of its employed physicians exceeded fair market value; that the structure of the practice of the employed physicians did not meet the “group practice” exception; that physician compensation improperly included payment work not performed by the physicians; and that the physicians were paid for making referrals to the system. Continue reading

Grievance Complaint against Orthopedic Surgeon by AAOS  resulted in a decision that there were no violations of Standards of Professionalism

After a grievance hearing  by American Association of Orthopedic Surgeons for  alleged violations of six Standards of Professions directed to Expert  Opinion and Testimony,  a hearing panel unanimously found that the orthopedic fellow had not violated any of the standards. The panel found  that the orthopedic surgeon was qualified to serve as an expert witness and had not violated any of the six mandatory Standards of Professionalism which were alleged to have been violated.  Therefore no action was warranted against him.