Healthcare Risk Management – August 1, 2016
August 1, 2016
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Ruling from the Supreme Court Raises Stakes on False Claims
In a decision that increases the risk of violating the False Claims Act (FCA), the U.S. Supreme Court ruled recently that an organization can violate the law if it relied on “implied false certification” when billing the government for services. The hospital or health system may have provided the services, but those services were rendered invalid because the organization — by not stating that it was noncompliant — falsely implied that it was in compliance.
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Supreme Court Rules on Implied False Certification
In Universal Health Services Inc. v. United States et al. ex rel. Escobar et al, the U.S. Supreme Court addressed a case involving Yarushka Rivera, a teenage beneficiary of Massachusetts’ Medicaid program who received counseling services for several years at Arbour Counseling Services, a satellite mental health facility owned and operated by a subsidiary of petitioner Universal Health Services.
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‘Perfect Compliance’ Impossible, Attorneys Argue
Perfection is unattainable when it comes to the myriad regulations that healthcare organizations must follow, according to an amicus brief in the case of Universal Health Services Inc. v. United States et al. ex rel. Escobar et al, on behalf of the National Association of Criminal Defense Lawyers.
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Protect Privileged Information in Adverse Events
Carefully consider the role of privilege in an adverse event investigation, says Amy Hampton, JD, partner with the law firm of Bradley Arant Boult Cummings in Nashville, TN.
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Tips on Interviewing Witnesses, Debriefing
In addition, the Agency for Healthcare Research and Quality (AHRQ) offers advice on how to debrief clinicians involved with adverse events. AHRQ notes that all forms of debriefing have a shared structure that involves setting the stage followed by three phases, including description or reactions, analysis, and application. The following is some of the advice from AHRQ:
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Ask the Hard Questions After an Adverse Event
Even when the cause of the adverse event is identified, investigators should drill down further to identify other factors that may have played a role, says Edwin G. Foulke Jr., JD, partner with the law firm of Fisher Phillips in Atlanta and former head of the Occupational Safety and Health Administration.
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CANDOR Toolkit Helps After Adverse Events
After an adverse event, prompt and honest communication with the patient and family members has become the best practice in healthcare over the past decade, and the federal government is supporting that effort with a new toolkit from the Agency for Healthcare Research and Quality.
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Feds Offer Best Practices Response to Ransomware
After a spate of attacks in which hospital computer systems were seized and held for ransom, the departments of Homeland Security, Justice, and Health and Human Services have issued technical guidance summarizing existing “best practices” to prevent and respond to ransomware incidents.
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National Fraud Takedown Nets 301 People And $900 Million in False Billing
The recent arrest of 301 people for healthcare fraud brings the campaign against fraudulent billing to another level and illustrates that licensed professionals are as vulnerable as everyone else.
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Patient Shot by Security Officer Sues Hospital
A patient who was shot by an off-duty police officer working security at St. Joseph Medical Center in Houston, TX, is suing the hospital, its parent company, the city of Houston, and four police officers.
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CNO Says Hospital Fired Her for Criticism of Electronic Medical Record
A former nursing executive at Sonoma West Medical Center (SWMC) in Sebastopol, CA, says she was fired for raising concerns that the facility’s electronic medical record was a threat to patient safety. The electronic medical record was developed by one of the hospital’s board members.
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$53 Million Award for Birth Brain Injury
In what is believed to be the biggest birth injury verdict ever in Chicago’s Cook County, a jury has ordered the University of Chicago Medical Center to pay $53 million in a case involving a 12-year-old boy who was born with a serious brain injury.
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Changes to Conditions of Participation Proposed
CMS has proposed changes to the Conditions of Participation that the agency says will improve patient safety and quality.
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Relying Exclusively on Family for Medical History Breaches Standard of Care, Yields $4.58M Verdict
On June 8, 2012, a 33-year-old woman drove to the hospital and was complaining of severe head pain and other symptoms. She told doctors that she had a history of brain swelling that was caused by a pre-existing condition known as lupus and was being monitored by a neurologist. The hospital diagnosed the woman with a migraine, administered a “migraine cocktail,” and then discharged her without providing a neurological consult, performing diagnostic imaging of her brain, or reviewing her past medical history. The next day, the woman died.
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Radiologist’s Failure to Diagnose Breast Cancer Results in Jury Verdict of $6.9 Million
In 2008, a 39-year-old woman underwent a mammogram. The doctor who reviewed the results reported that the calcifications, or calcium deposits, found in the woman’s right breast were benign. Although a prior mammogram screening in 2003 revealed no such calcifications, and the woman’s medical records reported a family history of breast cancer, the doctor did not order further diagnostic testing of the woman’s right breast.