UPMC is in hot water for its lung transplant program. They accepted a lung to transplant into one person but transplanted it into another without considering a wider array of candidates. They have been put on probation and can continue to operate but must tell patients of their status. Top
The Republicans are sometimes, if not always, their worst enemies. This time the conservative branch of the House has come up with a doozy of a replacement for Obamacare if the Supreme court rules against the insurance subsidies this month. The plan would not force people to buy insurance and would get rid of the mandates. That is good but then they go on to state people would be enticed to sign on for tax credits. They do not say what would happen to the poor who have no credits. This is their permanent fix but does not address the more pressing issue of what to do the millions that may lose their subsidies. They are attempting to bide time until there is a Republican president in 2017.
Medicaid continues to find ways to not have physicians participate in the care of their patients. The latest affront is the mandate that physicians, albeit only the those who are at the highest risk of defrauding the program, that treat Medicaid patients be subjected to background checks that include fingerprinting. The authorization is under Obamacare and the physician must pay. This also started a year ago for Medicare providers of the highest risk of fraud. Those that have been screed for Medicare do not have to do it again.
Another expert panel, The International Agency for Research on Cancer, has recommended mammograms for screening be at 50 years of age and not 40. Do not be surprised if the American Cancer Society does not re-look at their age recommendation soon.
The California Department of Managed Health Plans has fined California Blue Cross $1,500,000 for illegally billing 27,000 enrollees for their Alpha Feto Protein tests. They treated the tests as not of network when they were must under law be in network. Blue Cross agreed to the fine.
California continues to find ways to hurt patients in the name of saving money. The latest scheme it is allowing pharmacists to prescribe birth control pills. They passed this law several years ago and it now goes into action. They can also prescribe inhalers etc for nicotine addiction as well as travel immunizations and antibiotics. The law goes even father. It creates a super pharmacist who can change most medication dosage without a prescription as long as the medicine was originally ordered by a physician (provider). The state has tied safety with the pharmacist prescribing contraceptives, they will need one whole hour of post grad work. Top
Missouri is trying again. The Governor has signed a law putting a cap of $400,000 on non-economic personal injury in a med mal suit and $750,000 for a catastrophic injury, examples are death paralysis or lost vision. There is a 1.7% escalation clause.
New York is going the opposite way. Governor Cuomo is pushing Lavern's Law, not the same Lavern from the great TV show. This one had an x-ray that showed a treatable lung cancer but she was not told about it. She sued and lost since a suit against a public hospital must be filed within 15 months of the error not when the patient finds out. A settlement after the publicity gave her and her attorney $625,000, not the mega millions her attorney thought she was entitled to. Top
California is attempting to pass a law to prohibit physicians who see patients at an in network hospital to charge the patient regular prices. This mainly affects the RAPES. The ED physicians are already prohibited from "balance billing" the patient. This is very important as insurers reduce networks to save money. Physicians are being left off panels and are still slaves to the insurers. If it passes there must be an equitable way to have the charges mediated or arbitrated.
The OIG has issued a warning to physicians that they will be prosecuted if their contracts such as medical directorships are not truly fair market value. This includes having your front office people paid for by an allied health care entity. This was the case in some of the 12 recently dinged physicians who signed settlement agreements with the fed. Top
DISCLAIMER: Although this
article is updated periodically, it reflects the author's point of view at the
time of publication. Nothing in this article constitutes legal advice. Readers
should consult with their own legal counsel before acting on any of the