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The Joint Commission, shut out initially to NCQA, was awarded the ability to be a deeming authority for CMS. They will look at the Medicare + C and PPO plans to make sure they meet the requirements. Knowing JCAHO, they will also make new rules not intended by CMS and somehow learn to make more money via these rules. CMS only requires six areas for deemed status: Quality Assurance, Advance Directive Information, Antidiscrimination, Access to Services, Provider Participation Rules and Accuracy of Enrollee Records. If the plans are smart they will choose NCQA certification. Top
Nevada's Governor reached a verbal agreement with St. Paul Insurance to continue their coverage of Nevada physicians to May 1, 2002. This is important since the state's insurance doesn't kick in until April 15, 2002. St. Paul also may relent in their demand for a one time tail payment of $105,000 per physician. They may accept a payment schedule instead. In California, those physicians who have been with the physician owned carriers for a certain number of years have no tail coverage to pay.
South Texas physicians have staged a one day walkout to protest higher malpractice premiums. The governor at the same time has recommended changes in the tort system that coincides with California. The physicians and business groups praised the governor's statement with the trial lawyers opposing it. One of Governor Perry's recommendations was lawsuit immunity for those physicians who treat Medicaid patients. The proposals are to give a $250,000 cap on pain and suffering, special malpractice courts, limits on contingency fees, efforts to reduce medical errors, reorganization of the medical board's disciplinary procedures and temporary insurance coverage for those who have difficulty obtaining insurance. Top
Texas continues to fine companies for delinquent physician payments. The Insurance Commissioner has fined 13 PPOs for delayed payments. The total fine and restitution to be paid by May 31. The fines were for claims between August 1, 2000 and February 28, 2002. The legislature is being lobbied by industry to re-look at a bill previously passed and vetoed. The Insurance Commissioner does not feel any new law is necessary.
Conseco Medical Insurance has just paid Texas $1.3 million in restitution and fines for late physician payments. The company admitted no wrongdoing and would not comment on the fine. The company has paid$700,000 in restitution to doctors and hospital and an additional $377,000 to other providers. the fines totaled $250,000. Texas has a law that all clean claims must be paid within 45 days and that disputed claims need to be paid 85% within the 45 day period. Indiana has just joined Texas with the same law.
The Georgia House has approved a measure previously passed by the Senate to force the MCO to pay for all pre authorized procedures. They would also need to have staff available on a 24/7 basis to authorize urgent cases. The proposal would also limit the time an insurance company has to collect an erroneously paid claim.
Currently, in the Peoples Republic of Massachusetts there is a $20,000 cap on liability by HMOs. The state insurers and the business coalition are fighting a potential repeal of the cap. Top
Physicians in Alaska are attempting to have their state become the third to allow physicians to band together to bargain for their rights. The FTC has issued a news release to Alaska opposing the bill. They had done this in the past in the other two states with antitrust exemptions, New Jersey and Texas, that have had no effect. Top
As everyone knows California is a shaky state. They have a law that hospitals must be earthquake safe by certain dates. Sutter Health has announced they will spend $3.6 Billion for upgrades of their hospitals. This is a major expenditure for any health system but especially one who last year reported a net operating income of $35 million on revenues of $3.5 billion, a 1% margin. They will need to get up to a 3.5% margin to afford this retrofit. This means more money for the organization since the fat is now lean, but needs to be even leaner. Top
Eckert Pharmacy is being investigated by the Florida AG and sued for breach of privacy. The chain has the patient sign for the filled prescription but in small print is the release of information allowing the store to release the information to the headquarters for marketing purposes. Eckerd is owned by J.C. Penny. There has been no accusation that Eckerd has sent any information to them. The company defends its practices which would truly be OK if the release was in large print and the customer would not have to speak to pharmacy personnel to opt out. Eckerd's competitors do not have a signature requirement. Eckerd has been accused in the past of overcharging customers and has paid a fine of $1.7 million to settle a criminal overcharge case. Top
The Orange County Register in California had a story regarding the Medical Board only investigating 20% of the complaints against physicians. This is being discussed in the California legislature and what measures should be done. The article did not discuss the merits of the other 80% of complaints. It did discuss the lack of revocation of licenses but did not state the periods of years that the physicians are under scrutiny after a hearing. Governor Davis, up for re-election this year, quickly chimed in to support a sweeping review of the Medical Board.
In a separate matter Public Citizen again chimed in with their non informed poll of the best and worst medical boards. They continue to use the unusable percentage of the physicians in the state that have been disciplined as the criteria. This time they also ranked the state board web sites as to how much information was available about the physician on the site. I agree that web sites should have the information on any final state or hospital disciplinary actions but not those not final. 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 information presented.