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Medicare Fraud Bust Sends Warning to Healthcare Providers

The huge federal crackdown on Medicare fraud opioid abuse is a loud alarm bell for risk managers in all healthcare settings, signaling that the Department of Health and Human Services and the Department of Justice are not fooling around. They’re charging people by the hundreds, and for the first time a large proportion are healthcare professionals.

DOJ Launches Opioid Fraud Unit With Big Data

Soon after its largest-ever bust of healthcare providers involved in the fraudulent distribution of opioids, the Department of Justice announced a new Opioid Fraud and Abuse Detection Unit that draws on healthcare data analytics to find misuse of controlled substances.

Prescribing Opioids: Physicians Must Assess Carefully, Document Rigorously to Avoid Liability

The human toll of the opioid crisis is enormous, with millions of Americans suffering from addiction and more than 90 people dying each day from opioid overdoses. It is widely recognized that a significant part of the problem is the overprescription of pain medications, such as oxycodone and fentanyl. For physicians who prescribe such medications, this presents important challenges.

Health System Cuts Workers’ Comp With Best Docs

Health systems can significantly reduce their workers’ compensation expenses by identifying and using high-performing physicians in medical networks, according to the experience of operators of one system in California, which saw overall claims costs reduced by almost 20%.

OR Fire Safety Improving With More Drills, Less Alcohol Prep

Hospitals are taking fire safety in the OR seriously but still must conduct frequent reviews and update policies as necessary, says Solveig Dittmann, RN, BA, BSN, CPHRM, senior risk specialist with Coverys, a medical professional liability insurer in Boston.

Factor Consumerism Into Risk Management

Consumerism is a growing force in healthcare and should be incorporated into a hospital or health system’s risk management strategy, says Jane Harper, CISSP, CRISC, CRCMP, ISA, PCIP, CISA, ITIL, director of privacy and security risk manager at Henry Ford Health System in Detroit.

Lawyer Reprimanded for Penis Amputation Lawsuit

A lawyer who represented a client in a case that gained national media attention has been reprimanded by the court for not reviewing medical records to determine if his client’s case was viable.

Carolina Healthcare System to Pay $6.5 Million for False Claims

Carolinas Healthcare System (CHS) has agreed to pay the federal government $6.5 million to resolve allegations that the company violated the False Claims Act by up-coding claims for urine drug tests to receive higher payment than allowed for the tests.

Survey: Most Health Providers Use No Cybersecurity Software

Most healthcare providers do not use any software for information security governance or risk management to protect against cyberattacks, according to a recent survey, which also found providers fear their own employees the most.

Misdiagnosis Leads to Sepsis, Amputations, and $16.5 Million Verdict

News: In Wisconsin in mid-2011, a woman suffered gangrene, resulting in the amputation of her four extremities. The cause of the gangrene was a septic infection resulting from an untreated infection that was not disclosed to the patient, or treated. At trial, the jury awarded the patient $15 million, and her husband $1.5 million for loss of consortium.

Medical Malpractice Case Disguised as Fraud Dismissed

News: In 2011, a woman presented to a Missouri medical clinic for treatment relating to her inflamed gallbladder. During a diagnostic scan, the patient was injected with substances that ultimately caused her tremendous discomfort and psychological trauma. She filed suit against the medical clinic, claiming that alleged representations made by unidentified medical professionals amounted to fraud. The trial court granted the defendant’s motion to dismiss, finding the patient to have filed the petition untimely.

Myriad State Requirements Complicate Breach Response

When you realize there has been a breach of protected health information, your first thought is of HIPAA and how to satisfy federal requirements for responding. But that is far from the end of your obligation, as state requirements can be just as onerous.

New Breach Reporting Tool Helps With HIPAA Response

A new breach reporting tool should be useful for HIPAA compliance, partly because it can help providers stay on top of what is currently trending in cyberattacks and other types of breaches.

Per-record Cost of Data Breaches Increasing

The cost of healthcare data breaches continue to remain the highest out of any industry, with an average cost of $380 per record, according to a recent report from the Ponemon Institute.

Healthcare Risk Management – September 1, 2017

September 1, 2017