69 Indiana hospitals accused of retaining $324M in fraudulent EHR incentive payments

https://www.beckershospitalreview.com/legal-regulatory-issues/69-indiana-hospitals-accused-of-overbilling-for-medical-records-in-324m-scheme.html

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A recently unsealed lawsuit filed by attorneys under the qui tam, or whistle-blower, provision of the False Claims Act accuses Indiana hospitals of overcharging patients for their electronic medical records.

Here are eight things to know about the lawsuit.

1. After experiencing difficulty obtaining medical records from four Indiana hospitals in their work on personal injury and medical malpractice cases, attorneys from Anderson, Agostino & Keller sued the hospitals in September 2016. They alleged the hospitals falsely certified they were meaningful users of EHR technology.

2. Under meaningful use stage 1, hospitals could show compliance and receive incentive payments by filing attestation documents reporting compliance with core criteria requirements. The lawsuit against the Indiana hospitals focuses on core measure No. 11, which aimed to provide patients with electronic medical records within three business days of receiving a request from the patient or their agent.

3. To receive the incentive payments, hospitals had to show the number of medical record requests they received annually and if the records were supplied to those requesting them within three business days. Hospitals that failed to meet at least 50 percent of their requests within the time frame would not be eligible to receive incentive payments.

4. Based on their experience requesting records from the hospitals and after examining public disclosures, the lawyers alleged the hospital defendants falsely certified compliance with core measure No. 11.

5. The lawyers also claim the hospitals allowed CIOX Health, a company that provided medical records for the hospitals, to illegally profit from the release of the electronic medical records.

“CIOX routinely and repeatedly engaged in a practice, policy, and/or scheme to illegally and fraudulently over-bill patients for the provision of medical records,” the complaint states.

6. The lawyers added organizations operating an additional 65 hospitals to the lawsuit after examining disclosures and identifying a statistical trend that they argue indicates the same type of fraudulent reporting of core measure No. 11.

7. “In sum, these hospitals have been paid $324,386,169.32 in public funding from the citizens of the United States in return for the promise that patients would be provided with fast, cheap, easy access to their electronic health records, and these hospitals have failed to keep that promise,” the complaint states.

“A failure to properly track and report core measure 11 means that the defendant hospitals did not achieve ‘meaningful use’ as defined by the legislation and its ensuing rules. This means that they were not eligible to receive any funding under this program, and have sought and received the grant funding at issue in a fraudulent manner that constitute false claims for public funding.”

8. The Department of Justice declined to intervene in the lawsuit.

Sexual abuse scandals: What hospitals can learn from high-profile Hollywood, government cases of harassment

https://www.fiercehealthcare.com/healthcare/sexual-abuse-scandals-what-hospitals-can-learn-from-high-profile-hollywood-government?mkt_tok=eyJpIjoiWVRBeE5EQTFaREJqWVRJMiIsInQiOiJnUXl5b3pxcXlaRVo0Nm51UVcxOXdXd3IybE96SnNuOVhaNzR6UjBUMDMxdUJUN2h0MzlpNXdPRFdwcVwvS0MwQk1SSWdjMFM3T3FuN2tnbThoNjVzVmg2V0NEQmdrOXFcL05BQ1dRWCtkeExsbGxMTWJaMjUyMlwvUklJcGErd1BiYiJ9&mrkid=959610&utm_medium=nl&utm_source=internal

Female nurse looking stressed

While media attention has focused on the accusations of sexual misconduct among Hollywood heavy hitters, television personalities and politicians, the healthcare industry isn’t immune to misbehavior in the workplace.

Indeed, one of the biggest payouts for workplace harassment occurred in 2012 when Mercy General Hospital in California and its parent company, Catholic Healthcare West (now Dignity Health), were ordered to pay more than $167 million to Ani Chopourian, a former physician’s assistant who says she was fired after she complained of sexually inappropriate conduct, bullying and retaliation, in addition to inferior patient care by surgeons.

While USA Today reported that the judge later vacated the award after attorneys on both sides negotiated a settlement, the large payout should serve as a wake-up call to hospital leaders that they can’t ignore complaints of misconduct in the workplace.

The recent high-profile cases that have made national headlines also offers lessons to healthcare leaders. Lawyers say leaders must:

  • Establish policies that address disruptive behavior: Healthcare organizations must foster a culture of teamwork and the need for a safe, cooperative workplace, Anne Murphy, a Bloomberg Law advisory board member and partner at Hinckley Allen in Boston, told Bloomberg BNA.
  • Be willing to investigate complaints, even if they involve a high-profile physician: Hospital leaders must be willing and able to identify and avoid sexual harassment claims and apply the policies equally to everyone. Employees must feel safe to report complaints and leaders must be willing to address those complaints and not sweep them under the rug.

    “Healthcare entities must take these actions in spite of the prospect of losing a significant revenue generator or a critical skill in a single physician,” wrote Katherine Dudley Helms in National Law Review. “Failing to address the situation creates legal liability and sends a loud negative message to employees regarding the importance the organization places on its workforce versus certain key employees.”

  • Develop an action plan to address complaints: David Jarrard, president and CEO of Jarrard, Phillips, Cate & Hancock in Brentwood, Tennessee, told Bloomberg BNA that organization must have plans in place just as they would other responses to natural disasters or mass shootings.
  • Be aware of red flags: Sexual harassment claims shouldn’t come as a surprise. Often, gossip spreads among employees, so leaders should keep their ears open, Jarrard said. He told the publication that senior leaders must be visible and engaged with employees and patients.

    “Hospital leaders might hear about suspect behavior simply by getting out of their offices and walking the hospital’s hallways,” he said.

  • Monitor social media accounts: Jarrard also said that accusations of misconduct often will appear in social media platforms so leaders should monitor accounts for mentions of their organizations. This way they may be able to intervene before the situation becomes worse.
  • Consider peer intervention: Clinical leaders might be able to diffuse a situation by talking to the person accused of misconduct over coffee and before a formal complaint is filed, according to the article.

“Now is an excellent time to remind your employees of your refusal to accept this behavior,” said Helms in the National Law Review piece. “Remind employees and supervisory personnel of your harassment policies, and refresh your sexual harassment training.”