HHS Issues $4.3 Million Fine for HIPAA Violations

The Department of Health and Human Services (HHS) has imposed $4.3 million in fines against Cignet Health of Prince George's County, Maryland for violations of the HIPAA Privacy Rule.

The HHS Office of Civil Rights found that 41 patients were denied access to their medical records. The HIPAA Privacy Rule requires that this information be provided to patients within 30 days of the request.

To read more, click here:
http://www.hhs.gov/ocr/privacy/hipaa/enforcement/examples/cignetcmpresolution.html


Source: U.S. Department of Health and Human Services

HHS Proposes Rule Exempting Certain Law Enforcement Data from NPDB

The February 17, 2011 Federal Register includes a proposed rule issued by the Department of Health and Human Services (HHS) which would exempt law enforcement data connected to ongoing investigations from having to be reported to the National Practitioner Data Bank (NPDB).

The Privacy Act already exempts law enforcement information connected to ongoing investigations from having to be reported to the Healthcare Integrity and Protection Data Bank (HIPDB). Only law enforcement information connected to final adverse actions taken has to be reported.

The purpose of the rule is to prevent "[t]he premature disclosure of the existence of a law enforcement activity to an outside party(who may also be the subject of the investigation) could lead to, among other things, the destruction or alteration of evidence and the tampering with witnesses.”

HHS is accepting comments on the proposed rule through April 18, 2011. To see the proposed rule and instructions on how to submit comments, click here:
http://frwebgate1.access.gpo.gov/cgi-bin/PDFgate.cgi?WAISdocID=nnKHXl/0/2/0&WAISaction=retrieve


Sources: BNA, Federal Register

Are You HIPAA Compliant?

Has your organization conducted a risk analysis to ensure effective and appropriate administrative, physical and technical safeguards to secure electronic protected health information (e-PHI)? If not, every year, the Department of Health and Human Services Office of Civil Rights (OCR) develops guidance to help organizations comply with HIPAA privacy rules.

One recommendation from OCR's May 2010 guidance asks organizations if they have performed an analysis of possible risks and threats to health information. As technology has developed, so has the risk of committing a HIPAA violation, whether intentional or accidental. For example, social networking has made it easier for healthcare professionals to "vent" about a problem patient, and physicians are even starting to request that patient information be sent to them via text message. While not all of these may be HIPAA violations, the flow of patient information can certainly make employers and healthcare entities nervous.

For tips and guidelines on how to perform a risk analysis, see the following guidance and make sure that your employees and colleagues know the ins and outs of HIPAA: http://www.hhs.gov/ocr/privacy/hipaa/administrative/securityrule/radraftguidance.pdf


Source: HHS

AHRQ Report Provides High Performance Work Practices to Maximize Quality

The Agency for Healthcare Research and Quality (AHRQ) has released a report describing how healthcare entities can attract, hire, develop, and retain staff members who can contribute to higher healthcare quality. The report, titled Using Workforce Practices to Drive Quality Improvement, provides four high-performance work practice (HPWP) models that can be implemented in a facility.

The HPWPs focus on practices such as rewarding performance, providing career development opportunities, aligned decision-making, and ensuring that leaders are developed to carry out an organization's goals and mission.

The report can be found here:
http://www.ahrq.gov/qual/workforceguide.htm


Source: AHRQ

OIG Study Examines Medical School Education on Fraud and Abuse

There is and will continue to be more and more investigation into Medicare and Medicaid fraud and abuse which is costing the US taxpayers billions of dollars each year.

One question being discussed is where and when should medical students be provided with instruction on compliance with Medicare and Medicaid laws to prevent fraud and abuse, or is this better left to residency and fellowship training programs?

In the report from the Office of Inspector General (OIG), Department of Health and Human Services, it is reported that Medicare and Medicaid compliance is being provided in medical schools and graduate medical education programs:

44% of medical schools are providing instruction to students

66+% of graduate medical education programs and fellowship programs

The OIG realized that it is difficult for medical schools to incorporate comprehensive education on Medicare and Medicaid fraud and abuse into the medical curriculum. Therefore, it plans to develop educational materials that can be distributed to medical school programs and to engage in conversations with program directors regarding the usefulness of these materials.


To read the full report, click here:
http://oig.hhs.gov/oei/reports/OEI-01-10-00140.pdf

State Insurance Commissioners Vote to Approve More Stringent Rules

The National Association of Insurance Commissioners voted unanimously to endorse standards requiring that "80 percent of premium revenue be spent on medical care and 'activities that improve health care quality' for patients." This requirement was set in place by health reform legislation.

The standards set limits on what revenue spending is defined as improvements to health care quality, and what is considered to be compensation or administrative spending. The goal of the standards is to make insurance companies function more as providers of healthcare and less as for-profit companies.

Secretary of Health and Human Services Kathleen Sebelius is expected to take the recommended standards and propose them as a new regulation for insurance companies. Opponents of the recommendations argue that they will negatively disrupt the insurance industry by forcing companies out of business and reducing consumer choice.


Source: The New York Times
http://www.nytimes.com/2010/10/22/health/policy/22insure.html?_r=4&emc=tnt&tntemail0=y

Report Encourages Disclosure of Large-Scale Medical Mistakes

The Department of Health and Human Services' Agency for Healthcare Research and Quality (AHRQ) recommends that large-scale adverse events and medical mistakes should be reported by facilities, even though they do not result in patient harm. This recommendation was noted in a study titled, "The Disclosure Dilemma -- Large Scale Adverse Events," which was published in the New England Journal of Medicine.

The AHRQ encouraged facilities to personally contact all patients that may be affected by a large-scale error such as the use of improperly sterilized medical tools and equipment malfunctions, even if the patients suffered no effect. Facilities are concerned that reporting these events will cause psychological distress on patients that would have had no worries had the event gone undisclosed. They are also concerned that reporting events will place a burden of negative press on facilities.

The AHRQ recommends that facilities have a policy in place that sets a structure for reporting errors and reaching out to all affected patients with follow-up care and compensation.

To read the full study, click here: http://www.nejm.org/doi/full/10.1056/NEJMhle1003134


Source: BNA

Watch out for H.E.A.T.

The Obama Administration will be increasing the HEAT to help combat healthcare fraud. The US Attorney General and Secretary of Health of Human Services created the Healthcare Enforcement Action Team (HEAT) in 2009 to investigate cases of fraud. HEAT strike teams are currently present in seven cities. The increase will expand HEAT presence to twenty metropolitan areas.

The HEAT strike teams are responsible for targeting and investigating healthcare fraud cases, something that the FBI and Department of Justice have not been able to handle on their own. Billions of dollars are currently being wasted due to fraudulent claims. The Obama Administration hopes that the success of HEAT will help to prevent and recover these claims, so that money can be better spent on improving quality and controlling costs for Medicare beneficiaries.


Source: Lexology (log-in required)
http://www.lexology.com/library/detail.aspx?g=d1c31f72-1a22-41dd-a1b6-84a7f2c46d61&utm_source=Lexology%20Daily%20Newsfeed&utm_medium=Email&utm_campaign=Lexology%20subscriber%20daily%20feed&utm_content=Lexology%20Daily%20Newsfeed%202010-09-03&utm_term

Court Allows HHS to Recover over $300k in Claims

The US Court of Appeals for the Eleventh Circuit ruled that the US Department of Health and Human Services was entitled to recover $311,263 in claims filed by Florida Medical Center of Clearwater, Inc. (FMC). FMC had argued that the government suffered no loss or injury as a result of the claims and that repayment of the claims would constitute an excessive fine, which is barred by the Eighth Amendment.

The court sided with HHS, stating that the amount was simply a recovery of losses, and not a fine.

Dr. Surindar S. Bedi was president and majority owner of FMC, despite being subject to a 10 year exclusion from Medicare due to a previous violation. FMC's application to CMS did not disclose Bedi's affiliation. The court ruled that CMS was allowed to recover the payments not because of Bedi's standing, but because FMC's application omitted information about Bedi in its application.

This case emphasizes the importance of checking the Medicare Exclusion list to ensure that providers are in good standing, and that appropriate disclosures are made, should a provider be found on this list.

HHS Launches ESAR-VHP Website

The Department of Health and Human Services (HHS) has launched a new website with information on the Emergency System for Advance Registration of Volunteer Health Professionals (ESAR-VHP) program at www.phe.gov/esarvhp.

The ESAR-VHP program is intended to promote the efficient delivery of first response care in emergency and disaster situations through the creation of state plans and a registry of healthcare professionals. The new website provides reports and materials that communities can use in planning their own preparedness programs.

HHS has also established a YouTube channel at www.youtube.com/phegov where visitors can view testimonials and videos made by volunteers.


Source: HHS

President Obama Signs Health Reform into Law

Yesterday, President Obama signed HR 3590, "The Patient Protection and Affordable Care Act" into law. The Senate-created bill was passed by the House late Sunday night by a vote of 219 to 212. 37 Democrats joined all 178 Republicans in opposing the healthcare overhaul plan.

Although Congress has essentially completed health reform, there is still one more vote that can affect the final package. The Senate will vote on HR 4872, the House's reconciliation bill this week, which proposes amendments to HR 3590 to include some of the provisions that were included in the House's original proposal, but eliminated in the Senate bill that passed in the House on Sunday.

NAMSS has provided a summary of the major provisions included in the final health reform plan. Most of the changes affect changes to the payment system and do not have a direct impact on the daily work of MSPs. However, now that health reform has passed in Congress, there is still much work to be done by the federal agencies in order to put the rules and regulations of health reform into place. The quality-focused and workforce planning initiatives assigned to the Secretary of Health and Human Services could have an impact on the work of MSPs.

To read the summary, click here:
http://www.namss.org/Portals/0/Health%20Reform%20Summary.pdf

HRSA Replaces Data Bank Management

The Health Resources and Services Administration (HRSA) has confirmed the reassignment of the management team in charge of the Division of Practitioner Data Banks (DPDB), which is in charge of the NPDB and HIPDB reporting systems.

The reassignments come after a report by ProPublica, an independent, nonprofit investigative group revealed inadequate reporting to the databanks by 20 states. This report surfaced as the section 1921 expansion became effective, which requires states to report adverse licensure sanctions.

Darryl Gray, Director of DPDB, has been replaced by Mark Pincus, who served as the program's director prior to Gray's term.

While HRSA recognizes that the databank may have gaps, they still encourage entities to query the NPDB for sanctions, especially now that private healthcare entities have access to sanctions for all licensed healthcare providers under section 1921. HRSA is working with the states to strengthen the information in the NPDB, and announced that states that inadequately report to the system will be publicized in July 2010.


Source: Los Angeles Times
http://www.latimes.com/news/local/la-me-database2-2010mar02,0,2139660.story

OIG Report Evaluates Adverse Event Reporting Methods in Hospitals

A report by the Department of Health and Human Services Office of Inspector General (HHS OIG) finds that reviewing medical records made by nurses and physicians may be the most effective way to monitor the occurrence of adverse events in hospitals.

The report, titled Adverse Events in Hospitals: Methods for Identifying Events, implemented five screening methods to a random sample of 278 Medicare beneficiary hospitals over a 2-week period in 2008. The case study was performed in accordance with the Tax Relief and Health Care Act of 2006, which requires OIG to publish regular reports on efforts to better identify adverse medical events.

The five methods employed in the case study were:

• Nurse reviews of medical records;
• Interviews of Medicare beneficiaries;
• Two types of billing data analysis;
• and Reviews of internal hospital incident reports.

Each flagged event identified using one of the above methods was later reviewed by physicians. OIG determined that the most effective screening method was the nurse review, which identified the most adverse events.

OIG has recommended that the Centers for Medicare & Medicaid Services (CMS) and the Agency for Healthcare Research and Quality (AHRQ) continue to research methods for identifying adverse events in the review of medical records.

To read the full report, click here:
http://www.oig.hhs.gov/oei/reports/oei-06-08-00221.pdf.

Implementation of Section 1921

The Health Resources and Services Administration/Division of Practitioner Data Banks has has announced the implementation of Section 1921.

"Implementation of Section 1921 will expand the information contained in the National Practitioner Data Bank (NPDB) to include adverse licensure actions taken against all licensed healthcare practitioners and any negative actions or findings by State licensing agencies, peer review organizations, and private accreditation rganizations against all health care practitioners and entities.

This final rule increases the amount of information accessible to hospitals and other organizations through the NPDB. Under the final regulation, private sector (non-Federal) hospitals will now have access to adverse licensure actions taken against all licensed healthcare professionals such as nurses, podiatrists, chiropractors, and psychologists—not just physicians and dentists. At this time, only Federal hospitals have access to this information."

NAMSS will post the language of the Section 1921 regulation when it is published in the Federal Register this week.

Information on Section 1921 can be found here:
http://www.npdb-hipdb.hrsa.gov/.

OIG Report Evaluates State Adverse Event Reporting

A January 6 report by the Department of Health and Human Services Office of the Inspector General (OIG) reviewed 17 state adverse event reporting systems. In the report, the OIG found that seven states provided no public disclosures, three provided limited disclosures, and seven provided extensive public disclosures.

"Adverse events" are described as a situation where a patient is harmed in the course of receiving medical care, such as surgical site infections. The systems with "extensive reporting" disclosed the event and also provided the medical community with information and strategies on how to prevent future adverse events.

The report recommends that other systems follow the lead of the seven states with extensive reporting.

The following is a breakdown of the systems in the report:

• No Disclosures: Utah, Florida, Nevada, New York, South Carolina, South Dakota, Vermont
• Limited Disclosures: Colorado, Maine, Rhode Island
• Extensive Disclosures: Maryland, Massachusetts Board of Registration in Medicine, Massachusetts Department of Public Health, Minnesota, New Jersey, Oregon, Pennsylvania

The full report can be found here:
http://www.oig.hhs.gov/oei/reports/oei-06-09-00360.pdf.

California Physician Assistant Convicted of Medicare Fraud and Identity Theft

Los Angeles physician assistant Ronald Luis Bradshaw, an employee of Glenmountain Medical Group, was convicted of four counts of healthcare fraud, conspiracy to commit healthcare fraud, and aggravated identity theft on June 30 for stealing a doctor’s identity to collect $7.7 million in Medicare payments (United States v. Bradshaw).

A report by the Department of Justice states that from April 2005 to April 2008, Bradshaw ordered tests and prescribed durable medical equipment to Medicare beneficiaries under the apparent supervision of a doctor.

The doctor testified that he had never worked at the Glenmountain facility and that Bradshaw had written the prescriptions using his UPIN without his knowledge.

The Department of Justice and the Department of Health and Human Services have formed the Health Care Fraud Prevention and Enforcement Action Team (HEAT) to combat fraudulent healthcare claims such as this one. HEAT currently has teams in Los Angeles, Detroit, South Florida, and Houston.

MSPs have the ability to help in the battle against healthcare fraud. When credentialing Allied Health Professionals, ask yourself, “Did I remember to confirm the AHP’s supervising physician?” Also, examine current practices at your facility. Do you have best practices and procedures in place for ensuring that UPINs are kept confidential?

Healthcare fraud is costing the system millions of dollars. By asking yourself the two questions above, you can not only ensure that you have verified the identity of an AHP, but you can also prevent the types of fraud illustrated in this case, which drain funding from the beneficiaries who truly rely on Medicare and Medicaid coverage.

Source: BNA

Hospitals Recognizing Need for Emergency Planning Thanks to HHS Efforts

The University of Pittsburgh reports that since 2002, states have taken significant steps to raise awareness of the need for medical emergency managements planning, thanks in part to the Department of Health and Human Services' Hospital Preparedness Program (HPP). The report highlights the fact that many states have already created emergency hospital staffing and medical supply plans.

The HPP was established by the Department of Health and Human Services in 2002 to help hospitals prepare response plans to terrorist attacks, natural disasters, and other widespread incidents that may cripple a community's ability to provide emergency health care. Areas studied by the HPP include: interoperable communication systems, hospital evacuation, decontamination plans, and bed and personnel management.

Although improvements have been made, the report recognizes that additional efforts are still needed, including better coordination among regional Healthcare Coalitions.

The full report can be found here:
http://www.upmc-biosecurity.org/website/resources/publications/2009/pdf/Hospitals%20Rising%20to%20the%20Challenge_Published%20Final_4-21-09.pdf

Source: Department of Health and Human Services

CONNECT Helps Make Health IT Interoperable

The Federal Health Architecture, an initiative of the Office of the National Coordinator for Information Technology (ONC) has released CONNECT, free software which will allow existing health IT systems to connect to the the Nationwide Health Information Network (NHIN).

The NHIN will serve as the "network of networks," allowing previously non-interoperable health IT systems to connect and share data with each other. Standards for the NHIN were developed by the Secretary of Health and Human Services based on public and private interoperability specifications. The ONC is currently working on the legal framework of information sharing over the NHIN.

"This software will strengthen our health systems' ability to share data electronically and provide a wide range of benefits to citizens," said Robert Kolodner, M.D., National Coordinator for Health Information Technology. "Benefits include up-to-date records available at the point of care; enhanced population health screening; and being able to collect case research faster to facilitate disability claims, as demonstrated by transfers of information already underway between the Social Security Administration and MedVirginia, a regional health information organization."

More than 20 federal agencies will use CONNECT to access the NHIN, including the Department of Defense, Department of Veterans Affairs, Social Security Administration, and the Centers for Disease Control and Prevention.

Organizations can download CONNECT for free at: http://www.connectopensource.org/. Although the download is free, organizations will be responsible for the implementation and maintenance costs of using the program.

Source: Department of Health and Human Services

Blumenthal Named Health IT Coordinator for HHS

The Department of Health and Human Services (HHS) has selected David Blumenthal, MD, MPP to serve as the National Coordinator for Health Information Technology. Dr. Blumenthal will lead efforts to create a secure, interoperable health IT network. This effort, which is a priority for the Obama Administration, will be funded by $19.5 billion from The American Recovery and Reinvestment Act.

Dr. Blumenthal has extensive experience in health policy. He was recently a physician and director at the Institute of Health Policy at The Massachusetts General Hospital/Partners HealthCare System in Boston, Massachusetts. He was also the Samuel O. Thier Professor of Medicine and Professor of Health Care Policy at Harvard Medical School and served as director of the Harvard University Interfaculty Program for Health Systems Improvement. Prior to that, he was senior vice president at Boston's Brigham and Women's Hospital and served as executive director of the Center for Health Policy and Management and as a lecturer on Public Policy at the John F. Kennedy School of Government.

Dr. Blumenthal worked on Senator Edward Kennedy's Senate Subcommittee on Health and Scientific Research in the 1970s and as a senior health adviser to the Obama for America campaign. He has focused on issues such as the dissemination of health information technology, quality management in health care, the determinants of physician behavior, access to health services, and the extent and consequences of academic-industrial relationships in the health sciences.

Modernizing health care through the implementation of a health IT system by 2014 is expected to increase the safety and efficiency of care, minimize errors, and reduce the federal government's health care costs by $12 billion over 10 years.

Obama Nominates Sebelius to HHS, Appoints DeParle Head of White House Health Office

President Obama has nominated Governor Kathleen Sebelius (D-KS) to become Secretary of Health and Human Services. Sebelius replaces former Senator Tom Daschle (D-SD), who withdrew his name from consideration when questions arose over unpaid taxes.

Prior to serving as governor, Sebelius was the state’s insurance commissioner for eight years. As governor, she was praised for her ability to work with the heavily Republican legislature to address Medicare fraud and expand access to health care. She also gained national attention with her ability to win a second term as a Democratic governor in a Republican state.

Sebelius was an early supporter of Obama’s presidential campaign and was widely speculated as his possible running mate. She was originally considered for a Cabinet post in December, but withdrew her name in order to focus on the budget shortfall in Kansas.

Opposition to her nomination has come mainly from anti-abortion groups that believe Sebelius, who vetoed reproductive clinic restrictions as governor, may expand abortion rights in her role as Secretary of Health and Human Services.

Obama will not appoint Sebelius to head the new White House Office of Health Reform. Obama had originally intended to appoint Daschle to both the HHS and White House posts. Nancy-Ann DeParle has been selected to serve in the White House office. DeParle was commissioner of the Tennessee Department of Health and Human Services and was administrator of the Health Care Financing Administration, what is now known as CMS, under President Clinton. As the White House “health czar,” DeParle will be in charge of the President’s $634 billion initiative to expand and reform the current health care system.