June 15, 2010 Legislation





Alta Bates Hospital in Beserkly, California, has been fined $101,000 for violation of the State's aerosol transmissible disease standard.  The hospital was accused of violating standards that hospitalized two people with bacterial meningitis.  The hospital is appealing the fine. 

Over 100 California hospitals have been fined for not reporting adverse events.  The law states that these events must be reported to the state within 5 days of the event or the hospital will be fined $100 per day for every day over the five.  The hospitals have paid into the California General Fund (a sink hole) over $1 million dollars so far.  The highest fines are to Tri-City in San Diego county that when a new CEO came in found the problems and self reported.  The initial fine was over $130,000 but due to the circumstances was reduced to $76,000.  Salinas Valley Hospital got the highest single fee of $52,800 and they are appealing the fine.  Fourteen of the Kaiser hospitals were fined but all for fewer than 50 days in arrears. 

California has fined UCLA $95,000 for the multiple HIPAA violations in the case of Michael Jackson.  His death certificate was viewed over 300 times illegally.        Top


California has stated that in the past 10 years it has revoked the licenses of 1017 physicians, about 600 for criminal, substance abuse, mental illness or sexual misconduct.  Of those 123 physicians have sought reinstatement of their licenses and 66 were reinstated.  Of the 66 only one had another board discipline problem.  This is a great report.  

Florida has fined a surgeon, Bernard Zaragoza, of Coral Springs $5000 and given him 50 hours of community service for removing a kidney on a patient instead of the gall bladder.  He blamed it on the patient's anatomy and prior surgery on the patient.  The patient died of heart failure thee weeks later. 

Effective now is the new PECOS enrollment for physicians.  Those that do not enroll or who have not enrolled can not order or refer Medicare patients for any DME.  PECOS is not the same as an NPI which is required to bill.  Physicians in order to be enrolled must have filed a 8551 enrollment form since November, 2003.       Top


The US Senate is looking to pass a bill for extending unemployment benefits and adding to this a 2% increase in payments to physicians instead of a 21% decrease.  This is more than the House gave so it would now need to go back to the House for another vote.  They also put back into the bill the money the House took out of the Medicaid package.  This will make it difficult to get the House Blue Dogs to agree to pass the bill.  It is a shame they can not do individual bills so as to not gum up the works.   The Senate did follow the House in not passing any extension for COBRA benefits. 

Since the Senate as yet can not agree on the above bill which includes the delay in the 21% physician decrease in pay, CMS has decided to extend their non payments to providers an additional week to June 17.  We all know it still won't be done by then.  In the meantime physicians will feel the lack of cash flow.  The problem is that the physician pay will add to the national debt and was left off intentionally from the cost analysis of the health reform bill.  Republicans would like not to add to the debt and to offset the physician pay with a reduction somewhere else.  The Democrats want to continue to deficit spend.

Remember when Obama said the health law would not make anyone change their plans.  He did not speak with straight tongue.  The White House announced that new rules would affect small businesses from keeping their current insurance.  If any business does much changing in their insurance they would lose their grandfather status and lose a partial exemption to the health care plan.  This means they would lose the ability to not provide free preventative measures and "essential" health benefits as stated by the Feds. This would raise their premiums significantly. 

The first part of Obamacare is in action.  The checks for $250 have been mailed to those who have already reached the doughnut hole in Medicare Part D.  Now the states are reaching down to get those checks from the people who the state has paid the money for them when they reached the doughnut hole.  Vermont is the first state to go after the money that they paid out and the people didn't.

New York has passed a bill to allow the state to regulate insurer's fees.  Insurers must apply to the state to allow them to raise fees.  The bill seems to be aimed at HMOs in the state who have made big profits.  The new law requires insurers to spend 82% on medical care up from 75%.  The state must give an actuarial reason for the denial and if it doesn't act within 60 days the increase is deemed granted.  

Missouri has a new law signed by the Governor mandating autism coverage.  Group insurance regulated by the state must cover up to $40,000 a year for diagnosis and behavioral therapy up to adulthood.  This bill specifically requires ABA.  This is the 21st state to mandate the coverage.  There is also a cost of living escalator in the bill.  No one knows how much this will raise premiums for all Missouri citizens.     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.