The cases where hospitals are denied HCQIA immunity are few and far between, especially when that denial is predicated upon the due process requirement of HCQIA, because of the due process exception condoning procedures that are fair under the circumstances. In Smigaj v. Yakima Valley Memorial Hospital Association, the Washington Court of Appeals reversed a … Continue Reading
Ohio Valley Health Services & Education Corporation, Ohio Valley Medical Center and East Ohio Regional Hospital have collectively entered into a corporate Integrity Agreement with the OIG in September 2011, which focuses on what are defined as “focus arrangements,” which is defined as every financial arrangement between the hospital system and physicians covered by the … Continue Reading
An interim final rule has been recently published for "Adoption of Operating Rules for Eligibility for a Health Plan and Health Care Claim Status Transactions." Section 1104 of the Affordable Care Act establishes new requirements for administrative transactions that will improve the utility of the existing HIPAA transactions and reduce administrative costs. This interim final … Continue Reading
The case of Wood v. Archbold Medical Center Inc., presents an interesting twist regarding HCQIA immunity. The holding basically provides that “professional review activity” is a lesser level of adverse activity and need not meet the due process standards of HCQIA in order for a hospital to retain HCQIA. In Dr. Wood’s situation, there were three … Continue Reading
In KD v. United States, a decision by the United States District Court for the District of Delaware, both granting and denying a motion for a protective order in parts, indicates that PSQIA of 2005 has changed its opinion regarding the protection of peer review documents under federal common law privilege. The opinion notes that … Continue Reading
The Patient Protection and Affordable Care Act (PPACA) contains several provisions aimed to reduce fraud and abuse in home health and Durable Medical Equipment (DME) programs, which CMS and OIG consider to be high risk programs. Effective July 1, 2010, physicians who order covered home health or DME services must be enrolled in Medicare (§ 6405). … Continue Reading
