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GAO report details abuses in use of False Claims Act
The Chicago-based American Hospital Association (AHA) says a Government Accounting Office (GAO) report, published Aug. 6, vindicates AHA’s position that abuses are occurring in the use of the False Claims Act against hospitals.
In its review of the five U.S. Attorneys’ offices that were conducting the lab unbundling investigation, the GAO found that, at the time allegations were made against hospitals, "most of the offices had not sufficiently analyzed the claims data to determine if the pervasiveness and magnitude of the apparent errors were sufficient to warrant a False Claims Act violation."
The GAO report (GAO/HEHS-99-170) also states that, a year after establishment of the Department of Justice guidelines, four of the five U.S. Attorneys’ offices reviewed by the GAO had not corrected their mistakes and have yet to comply with the guidance. In one of these districts, GAO discovered that there was never evidence of fraud or abuse by the accused hospitals and that the hospitals "had actually been selected primarily because they were the largest billers of Medicare in the state."
"This is an outrageous abuse of prosecutorial power and the [Department of Justice] should take all necessary steps to stop it," says Dick Davidson, AHA president.
HCFA announces Medicare payment increases
The Health Care Financing Administration (HCFA) has announced that more than 5,000 acute care hospitals in the United States will receive an average 1.1% increase in Medicare payment rates in fiscal year 2000. The recommended payment increases are contained in a final rule published in the July 30 Federal Register.1
The rate increases, which are authorized by the Balanced Budget Act of 1997 (BBA), affect acute care hospitals participating in Medicare.
Medicare pays for most inpatient hospital care through a prospective payment system (PPS), which pays hospitals a predetermined amount for each Medicare discharge based on the patient’s diagnosis. Hospitals in large urban areas — cities with populations of more than one million — receive slightly higher payment rates than hospitals in other urban and rural areas.
The BBA allows for an increase in FY 2000 of 1.8 percentage points less than the projected growth in the inflation rate for goods and services — known as the marketbasket — purchased by hospitals. The latest forecast of the 2000 marketbasket is 2.9%, up from the estimate of 2.7% in the proposed rule. According to the formula included in the BBA, payments to PPS hospitals, sole community hospitals, and Medicare-dependent rural hospitals will increase on average by 1.1%.
Reference
1. 99 Fed Reg 19,334 (July 30, 1999).
Report compiles state privacy laws
States have passed a broad array of laws to protect the privacy of medical records, but those laws apply unevenly, even within states, according to a report released in July.
The report from the Georgetown University Health Privacy Project in Washington, DC, is the first to attempt to compile in one place state laws on medical record confidentiality, says project director Janlori Goldman. The project is part of Georgetown’s Institute for Health Care Research and Policy.
That fact that some states have fairly comprehensive laws while others have only minimal protections was not a surprise, says Joy Pritts, the report’s principal author.
What was surprising, Pritts adds, was that state laws tend to focus only on certain entities or certain conditions. "In some states, you can see your hospital records, but not those kept by doctors or insurance companies."
The complete report is available on the project’s Web site: www.healthprivacy.org/ resources.
Database offers data from hospitals, managed care
A new database that combines comprehensive hospital data with the latest managed care information is now available from the Chicago-based American Hospital Association’s (AHA) subsidiary Health Forum and InterStudy, a supplier of managed care data.
The Duet Database provides health care leaders and researchers with a wide variety of information about hospitals and managed care in local markets, at every metropolitan statistical area (MSA) level. MSAs are geographic areas defined by the U.S. Census Bureau, which generally contains a city with surrounding suburbs over 50,000 in population.
The hospital information comes from the AHA annual survey. The managed care data, which come from InterStudy, focuses on "public" HMOs — which are open to the public — vs. employer-owned HMOs. The CD-ROM product allows users to look at multiple cities and compare the penetration rates of managed care companies and hospital admissions.
The database is available in three formats at varying prices:
• hospital and managed care data for $3,000;
• hospital data only for $1,800;
• managed care data only for $1,800.
The database will be updated twice a year. To order, call (800) AHA-2626 or Interstudy Publications at (800) 844-3351.
Health care Y2K guide available for consumers
An information technology research firm in the health care industry has produced a 24-page booklet aimed specifically at helping consumers understand the year 2000 (Y2K) date change.
In developing the booklet, Odin Group LLC, in Nashville, TN, worked with more than 40 health care companies. In addition, Odin received help from the Department of Health and Human Services, the Health Care Financing Administra-tion, the Food and Drug Administration, and health care trade organizations and consumer groups.
The Personal Planning Guide will be available to consumers in a variety of ways. Many of the organizations involved in developing the booklet, in addition to pharmacies, physician groups, and hospitals are planning to distribute it, with the bulk reaching consumers over the next two months.
The booklet describes the efforts of various segments of the health care sector to prepare for the Y2K computer issue — the inability of some computers and electronic chips to properly recognize dates after 1999.
Also in the booklet are practical recommendations for all consumers to follow to determine how ready their personal health care providers expect to be. In addition, the booklet contains a basic health care checklist and a worksheet to record important personal health information for consumers and their families.
The booklet also is available on the Internet at www.healthcarey2kguide.com, or by calling (888) 353-7807.
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