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California Lawsuits to Define Managed Care Department Authority |
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After taking on the chin for stating they would not pay the hospitals for their 2002 outpatient (Part B) work until April due to a computer problem, The CMS has backtracked. They now state that the hospitals will be paid the 2001 rates until April 2002 when the computer upgrade will be finished. At that time there will be an accounting of what was paid and what was owed. Top
California Lawsuits to Define Managed Care Department Authority
The HMOs and IPAs have started to sue the Department of
Managed Care in greater frequency. This is to either set the parameters or
the Department's authority or to harass the Department. Kaiser tried and
failed to sue the Department's head individually for trying to fine them for the
systematic poor care rendered in their emergency room causing three
deaths. Now Blue Shield is suing to prevent the state's plan to utilize independent
medical reviews for patient disputes. This suit is being prompted by the
Department requesting an independent review of Blue Shield's disallowing the
patient's coverage of Xenical for treatment of her morbid obesity. The independent
review conducted without Blue Shield's consent sided with the woman.
The Department has proved to be a thorn in the managed care side by sanctioning
plans and medical groups 48 times in the past 1 1/2 years of its existence.
The CMA is attempting to prevent the release of information on the financial
stability or instability of the medical groups that contract with the HMOs and
the physicians. Many of the medical groups are functionally
bankrupt.
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JCAHO has suspended its earlier directive that hospitals bow and scrape to each of JCAHO's alerts. The hospitals no longer have to start consideration of all alerts but only the short list that the voluntary organization deems necessary. This allows the alerts to remain educational and not punitive. Their latest one was the wrong site surgery. This is a problem for those hospitals that do not use common sense and check the site with the patient preoperatively. Top
OSHA has a new directive to its inspectors. Hospitals
need to comply with the Bloodborne Pathogen Standard by having an exposure
control manual, a log book and non-managerial employee participation in deciding
safer safer devices. The products and devices can be found at
http://www.med.virginia.edu/epinet/safetydevice.html
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.