Healthcare Law Briefs

Meeting the Challenge of Health Law

	What's Inside
	MCARE Reporting Obligations

	California Court Enforces Nurse Staffing Ratios
	Compliance Developments

Healthcare Law Briefs

May 28, 2004

*READ PAST ISSUES OF THE HEALTHCARE LAW BRIEFS

1. MCARE Reporting Obligations

The Pennsylvania Medical Care Availability and Reduction of Error Act ("MCARE") has two reporting requirements, one for physicians and one for hospitals. Section 903 requires physicians to report medical malpractice complaints or notices, information regarding disciplinary action and information regarding sentences for certain specific crimes to their medical boards within 60 days of the occurrence. Section 313(g) requires medical facilities (hospitals, ambulatory surgery centers, and birth centers) to report serious events, incidents and infrastructure failures within 30 days of their occurrence.

The Pennsylvania Department of Health issued regulations on May 8, 2004 requiring that the western counties (including Allegheny, Westmoreland, Washington, Beaver, and Butler) begin reporting as of June 21, 2004. The eastern counties must begin reporting June 7, 2004 and the central counties must begin on June 28, 2004. The specific counties are listed in the Pennsylvania Bulletin.

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2. California Court Enforces Nurse Staffing Ratios

The California Court has recently issued a decision enforcing the nurse staffing ratio of regulations in California. In California Healthcare Association v. California Department of Health Services, the California Healthcare Association ("CHA"), the hospital industry organization, sought to enjoin the California Department of Health Services ("CDH") from promulgating and enforcing certain aspects of the Nursing Staffing Ratio Law, specifically the provision that the staff ratios must be maintained even though nurses are on breaks. CHA argued that these regulations were too restrictive because of nursing shortages and that they exceeded the authority of CDH. In a ruling that also indicated the Court's annoyance with CHA in waiting until December 30, 2003 to file the litigation, which was two days before the regulations were to take effect but three years after the regulations were initially promulgated, the Court rejected CHA's positions. The California Nurses Association stated that, "This is a searing indictment of the hospital industry's illegitimate attempt to deny patients safe care as required by the legislature, the governor, and the Department of Health Services � and a huge victory for RNs and patients".

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3. Compliance Developments

Pennsylvania will participate in a computer matching program developed by CMS with five other states, i.e., Illinois, New Jersey, North Carolina, Florida and Texas, to study claims, billing and eligibility information and to detect suspected incidences of Medicare or Medicaid fraud and abuse. This program will run for at least 18 months. CMS announced that, utilizing fraud detection software, the shared information will be used to identify patterns of abuse such as:

(1) billing for provision of more than 24 hours of services in one day,

(2) providing treatment for services in ways more statistically significant in similar practitioner groups, and

(3) upcoding and billing for services more expensive than those actually performed.

In another development, CMS is enlisting hospitals for a pilot program to review the efficiency of compliance programs. This 18-month study will involve 10 to 12 hospital volunteers. The Healthcare Compliance Association is contacting members to solicit volunteers for this project. The problem with soliciting volunteers is that, according to CMS' project manager, Lisa Eggleston, any problems discovered will "be treated like any other administrative audit". This program is restricted to volunteers in the New England and Mid-Atlantic area, including New Jersey, Pennsylvania and West Virginia.

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>For more information about the topics presented in this newsletter please contact one of the Healthcare Attorneys: