Healthcare Law Briefs
1.
OIG
"Publicizes" Enforcement Action
Effective March 18, 2003, OIG began
posting information about enforcement actions on its website.
Listed under the key "Fraud Prevention and Detection", this new section
lists details about civil and criminal enforcement actions, which make
it clear that OIG is prosecuting healthcare providers for kickbacks in
areas such as space rental, diagnostic imaging, cardiology testing, home
health, and prescription drug areas. The site is
www.oig.hhs.gov/fraud/enforcement/administrative/cmp/cmpitems.html,
and it is also accessible through a link on our website.
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2. Operation Hardgear
The OIG's pursuit of fraud in the DME
industry continues. On March 18, 2003, DME company owner in
Florida was sentenced to seven years in prison and ordered to pay $14.4
million in restitution. (U.S. v. Haught, M.D. Fla. No.
8:02-CR-19-T-27EAJ). In addition, at least ten other individuals
and twelve corporate defendants have entered guilty pleas in Operation
Hardgear.
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3.
Malpractice Insurance Crisis Fix Clears Legislature, Heads to Governor
From BNA's Health
Care Daily Report Friday, March 7, 2003
CINCINNATI--Compromise
legislation intended to resolve West Virginia's medical malpractice
insurance crisis (H.B. 2122) moved on to the governor's desk March 6.
The legislation includes
tort reform, tax breaks, and a physicians' mutual company. Deemed one of
the most important bills the West Virginia Legislature would tackle this
session, the malpractice measure reconciled earlier versions passed by
both chambers and was approved March 5. The House approved it in a 91-4
vote, and the Senate voted 33-1.
Brokered by conference
committee, H.B. 2122's final form retains the less-stringent damage caps
adopted by the Senate: $250,000 for noneconomic damages, $500,000 for
wrongful death or permanent disability, and $500,000 in trauma cases
where care was "rendered in good faith."
Under the original House
version, all damages would have been capped at $250,000 (No. 10 HCDR
1/15/03 ).
The bill would also modify
joint and several liability, limiting a doctor's or a hospital's damage
award exposure to the percentage of blame assigned by the jury.
In keeping with Gov. Bob
Wise's (D) malpractice reform proposal, jury awards would have to take
into account all payments from "collateral sources" like health
insurance and Workers' Compensation, plus settlements with other
defendants.
Tax Help
The measure calls for tax
credits to offset the cost of coverage, as suggested by the governor in
January during a surgical shutdown by doctors in the state's Northern
Panhandle who were frustrated by high malpractice premiums.
The bill would give
physicians $10 million in provider tax credits over the next two years,
giving doctors burdened by high insurance costs some financial relief.
West Virginia's provider tax is used to fund, in part, the state's
Medicaid program.
Doctors who pay annual
insurance premiums of $30,000 to $70,000 would receive a provider tax
credit of 10 percent; those who pay premiums of more than $70,000 would
be given a 20 percent credit. The credits could be carried over from one
year to the next.
Dissenter
Senate Majority Leader Truman Chafin (D), the chamber's sole dissenting
vote, said the bill violates West Virginia's Constitution by providing
tax breaks to a single class of people. "We placated doctors instead of
addressing the real problem of an unregulated insurance industry," he
said.
Defending the tax credit,
within the text of the bill, lawmakers said that retention of physicians
practicing in the state is in the public interest and promotes the
general welfare of the people.
Physicians' Mutual
Insurance Company
Perhaps the greatest hope
for reducing malpractice insurance costs lies in the bill's language
that would establish a physicians' mutual insurance company.
"We want to compel
creation of a physicians' mutual," Rep. John Amores (D), chairman of the
House Judiciary Committee, said during debate on the proposal. "That is
one of the major stated intents of this legislation."
If the bill becomes law,
the mutual company would be capitalized with a $24 million loan from
West Virginia's tobacco settlement fund.
Additional monies would
come from physicians, who will pay a one-time assessment of $1,000. Some
doctors will be exempt from the fee, such as faculty physicians and
residents. All private insurers doing business in the state would pay a
$2,500 one-time assessment to establish the physicians' mutual.
Lawmakers want the
physicians' mutual to replace a state-run program, offered through the
Board of Risk and Insurance Management, that currently insures more than
1,000 doctors who cannot obtain affordable malpractice coverage
elsewhere.
While "getting the state
out of the insurance business" was a high priority, said Amore, the
conference committee working on H.B. 2122 removed a "poison pill"
provision that would have nullified tort reform if the physicians'
mutual fails to become reality. The tort reform provisions are a
separate issue, he said, and should improve the market for private
insurance.
Under the bill, the
physicians' mutual must begin operation by July 2004. Physicians,
however, will not have any real say in the mutual until 2005, according
to Douglas McKinney, president of the West Virginia State Medical
Association.
Nonetheless, said
McKinney, most physicians in the state are happy with the medical
malpractice compromise package, particularly the tort reform.
West Virginia has been
grappling with medical malpractice since 2001, when Wise first proposed
a state-run insurance program to help doctors from leaving because of
high premium costs.
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4.
Tucker Arensberg Attorney Will Act as Moderator for American Health
Lawyers Association Teleconference
On May 1,
Mike Cassidy
will act as Moderator in the Strategies in Reporting to the Data Bank
Teleconference, co-sponsored by the HMOs and Health Plans and
Credentialing and Peer Review Practice Groups from the American Health
Lawyers Association.
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5.
OIG Posts Final Compliance Program Guidance for Ambulance Suppliers
The HHS Office of Inspector General has posted
to its website today the final Compliance Program Guidance for Ambulance
Suppliers. You can get to the document by going here:
http://oig.hhs.gov/fraud/docs/complianceguidance/032403ambulancecpgfr.pdf
Also on the website is a Press Release on this
final Compliance Program Guidance. For the release, follow this link:
http://oig.hhs.gov/publications/docs/press/2003/032403release.pdf
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>For more information about the
topics presented in this newsletter please contact one of the Healthcare
Attorneys:
>Read
the Fall 2002 issue of our HEALTHCARE
NEWSLETTER.
 Tucker Arensberg,
P.C.
1500 One PPG
Place Pittsburgh, PA 15222 412/566-1212
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