Healthcare Law Briefs
May 9, 2005
1. Top Compliance Enforcement Initiatives
U.S. Attorneys
speaking at the Health Care Compliance Association 2005 Compliance
Institute identified some of the top compliance enforcement initiatives
for 2005. Among the categories listed were the following:
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Section 921 of the Medicare Prescription Drug, Improvement and
Modernization Act of 2003, which became effective earlier this year,
requires Medicare contractors to respond to written or electronic
inquiries regarding billing issues within 45 days.
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The Office of the Inspector General of the Department of Health and
Human Services issued revised hospital compliance guidelines on January
27, 2005, which can be accessed on the OIG’s Web site at
http:/oig.hhs.gov.
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Effective compliance programs should include provisions for voluntary
and/or mandatory disclosures of problems.
The speakers also noted that the majority of the HIPAA complaints
referred for criminal prosecution involve disclosures of PHI in divorce
and custody cases, so remember to pay particular attention to the
privacy rules when disclosures are requested in these situations.
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2. Antitrust Enforcement Moves East
The FTC has
been reporting resolution of a number of cases involving independent
practice associations (IPAs) in the western United States. On May 2,
2005, the FTC announced an IPA in Cincinnati will be disbanded to
resolve charges that new Millennium Orthopaedics, LLC, resolving charges
that its two constituent groups engaged in prohibitive joint
negotiations. The two groups involved were Orthopaedic Consultants of
Cincinnati, Inc. doing business as Wellington Orthopaedics and Sports
Medicine and Beckman Orthopaedics and Sports Medicine.
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3. JCAHO -- The Latest Medical Staff
By-Laws Requirements
Medical
Staff Standard MS.1.20 has been delayed until January 2007. This new
standard would have prevented unilateral amendment of the Medical Staff
By-Laws by the hospital, and it has generated significant controversy.
JCAHO was proposing a new element of performance (EP 19) which will
require that the Medical Staff and governing body agree in the
following:
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The
issues that must be addressed to the Medical Staff By-Laws.
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The
criteria used to identify the issues that must be addressed to the
Medical Staff By-Laws.
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The
process used for joint adoption/approval or other issues that are
addressed in rules, regulations and policies.
More
information about this can be obtained on the Web site of JCAHO at
www.jcaho.org.
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>For more information about the
topics presented in this newsletter please contact one of the
Healthcare
Attorneys:
Read
the March issue of our HEALTHCARE NEWSLETTER.
 Tucker Arensberg,
P.C.
1500 One PPG
Place Pittsburgh, PA 15222 412/566-1212
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