Archive for the ‘Compliance Programs’ Category
Wednesday, April 22nd, 2020
When Employed Physicians be Required to Make Referrals for Designated Health Services
The Stark Law Regulations include a provision that dictates the conditions under which an employer of a physician may mandate referrals for designated health services. Certain specific conditions must be met if an employer wishes to require its employed physicians to make referrals to the employer’s designated health services. Many institutions assume that an employer may always require an employed physician to make referrals to its ancillary services. That assumption is not correct.
The Stark regulations provides that a physician’s compensation from a bona fide employer or under a managed care contract or other contract for personal services may be conditioned on the physician’s referrals to a particular provider, practitioner, or supplier. There are a number of specific requirements that must be present to permit referral requirements including:
- The required referrals can only relate to the physician’s services covered by the scope of the employment or the contract.
- The referral requirement must be reasonably necessary to effectuate the legitimate business purposes of the compensation arrangement.
- The physician’s compensation must be set in advance for the term of the agreement requiring referrals.
- The physician’s compensation must be consistent with fair market value for services performed (that is, the payment may not take into account the volume or value of anticipated or required referrals).
- The arrangement must otherwise comply with an applicable exception under Sec. 411.355 or Sec. 411.357.
- The requirement to make referrals to a particular provider, practitioner, or supplier is set forth in a written agreement signed by the parties.
- The requirement to make referrals to a particular provider, practitioner, or supplier may not apply if the patient expresses a preference for a different provider.
- The referral requirement may not apply to cases where the patient’s insurer determines the provider, practitioner, or supplier;.
- The referral requirement may not apply where the referral is not in the patient’s best medical interests in the judgment of the referring physician.
- There can be no requirement that an employed physician make referrals that relate to services that are not provided by the physician under the scope of his or her employment or contract.
This scenario most commonly applies in cases where a hospital or health system employs a physician and requires direction of referrals to the system’s designated health services. It is not uncommon to see a health system contractually require employed doctors to refer to the hospital or ancillary services of the hospital. The Stark Law permits the employing hospital to require referrals subject to these conditions. It is also common to see referral requirements without including in the contract the various conditions that must be present to permit the direction of referrals. The Stark Law would cast a shadow over a compensation arrangement with an employed physician that requires referrals without subjecting the referrals to the conditions set forth in the Stark regulations. Failing to subject the required referrals to the Stark Law conditions would seem to make the compensation arrangement illegal. Any referral made to the hospital’s designated health services may be tainted and reimbursement arising from the illegally required referrals would be prohibited.
Stark Law Provisions Relating to Referral Requirements of Employed Physicians
The following is the exact wording of the portion of the Stark Law that established the various conditions that must be met in order to permit the provider of designated health services to require employed physician’s to refer to its DHS.
42 C.F.R. § 411.354(d)(4)
(4) A physician’s compensation from a bona fide employer or under a managed care contract or other contract for personal services may be conditioned on the physician’s referrals to a particular provider, practitioner, or supplier, provided that the compensation arrangement meets all of the following conditions. The compensation arrangement:
(i) Is set in advance for the term of the agreement.
(ii) Is consistent with fair market value for services performed (that is, the payment does not take into account the volume or value of anticipated or required referrals).(iii) Otherwise complies with an applicable exception under §411.355 or §411.357.(iv) Complies with both of the following conditions:
(A) The requirement to make referrals to a particular provider, practitioner, or supplier is set forth in a
written agreement signed by the parties.
(B) The requirement to make referrals to a particular provider, practitioner, or supplier does not apply if the patient expresses a preference for a different provider, practitioner, or supplier; the patient’s insurer determines the provider, practitioner, or supplier; or the referral is not in the patient’s
best medical interests in the physician’s judgment.
(v) The required referrals relate solely to the physician’s services covered by the scope of the employment or the contract, and the referral requirement is reasonably necessary to effectuate
the legitimate business purposes of the compensation arrangement. In no event may the physician be required to make referrals that relate to services that are not provided by the physician under the scope of his or her employment
or contract.
Tags: Referral Mandate, referral requirements, Stark Law
Posted in Clinical Integration, Compliance Programs, False Claims Act, Fraud and Abuse, Physician Employment Issues, Physician-Hospital Organizations, Physicians and Group Practices, Reimbursement, Safe Harbor Regulations, Stark Law and Self Referral | Comments Off on When is a Referral Mandate for Employed Physicians Permitted under the Stark Law?
Monday, October 29th, 2018
IT Donation to Facilitate Telemedicine Consultations – Low Risk of Fraud says OIG
The Office of Inspector General (“OIG”) of the U.S. Department of Health and Human Services issued Advisory Opinion No. 18-03 in support of an arrangement where a federally qualified health center look-alike (the “Provider”) would donate free information technology-related equipment and services to a county health clinic (the “County Clinic”) to facilitate telemedicine encounters with the County Clinic’s patients (the “Proposed Arrangement”). The OIG concluded that although the Proposed Arrangement could potentially generate prohibited remuneration under the federal Anti-Kickback Statute (“AKS”) and Civil Monetary Penalties Law (“CMPL”) with the requisite intent to induce or reward referrals of federal health care programs, the OIG would exercise its discretion and not sanction the Provider or the County Clinic (collectively the “Requestors”).
The OIG’s analysis and conclusion of the Proposed Arrangement provides new insight into the government’s position on these type of donations that facilitate telemedicine encounters. Specifically, how the government views these type of donations with the continued expansion of coverage and reimbursement of telemedicine services under federal health care programs. The Advisory Opinion indicates support for the development of collaborative telemedicine affiliations and that the potential remuneration from the future referrals can be outweighed by the access to health care services and benefits actually received by rural or remote communities.
The County Clinic is a division of the County Department of Health that furnishes certain confidential sexually transmitted infection testing, treatment and counseling. The Provider has an existing referral relationship with the County Clinic but the facilities are separated by about 80 miles making it difficult for patients to access the Provider. Under the Proposed Arrangement, the Provider would donate information technology-related equipment and services to the County Clinic to facilitate telemedicine encounters between the Provider and the County Clinic’s patients for certain HIV prevention and treatment services. The Provider would cover the costs of the equipment, its set up, and maintenance through grant-funding from the State Department of Health. The Provider would bill the Medicare program for the professional services delivered in the telemedicine encounters. The County Clinic would house the equipment and bill the state Medicaid program an originating site fee related to the telemedicine encounters. The originating site is not required to provide any personnel or equipment in order to bill for the facility fee (Q3014) (which is only a coverage requirement to provide the telehealth consult).
OIG Analysis
Under the Proposed Arrangement, the County Clinic would receive remuneration of the free equipment and services and the Provider would have the opportunity to bill for the telehealth consultation referred by the County Clinic. As such, the OIG acknowledged that the Proposed Arrangement could potentially generate prohibited remuneration under the federal AKS with the requisite intent to induce or reward referrals of services payable by a federal health care program. However, the OIG identified the following factors as minimizing the potential risk of fraud and abuse:
- There are safeguards in place to prevent patient steering to the Provider for treatment; namely use of technology with any other provider is not restricted and patients are given the option to have either a virtual or in-person consultation
- Not likely to result in patient steering for prescriptions to any pharmacy operated by the Provider or County Clinic
- There would be no increased cost to any federal health care program
- Patients would benefit by having increased access to treatment; making it more likely that patients will seek out and receive such services
It is important to keep in mind that under the Proposed Arrangement the County Clinic would not obtain ownership of the equipment, as the Provider would use grant funds awarded by the State Department of Health to cover the costs of the equipment and services and the state agency would retain title and have the authority to recover the equipment at any time. This could prove to be an important distinction concerning whether and how donating providers can provide information technology-related equipment and services to referring facilities in the other arrangements.
In prior Advisory Opinions (99-14, 04-07 and 11-12) concerning donations of information technology-related equipment and supplies, the OIG similarly concluded that it would not pursue sanctions; however, those proposed arrangements would not have directly resulted in a service payable by a federal health care program, but rather would only potentially result in other items or services to the patient by the donating provider. Under the Proposed Arrangement, both the County Clinic and the Provider would be in a position to submit claims to a federal health care program as a result of the telemedicine encounter and follow-up services. Nevertheless, the OIG concluded that there would be no increased cost to any federal health care program because the County Clinic would have performed the preliminary tests and referred clinically appropriate patients for in-person consultations and, potentially, follow-up items and services regardless of the Proposed Arrangement.
While the analysis acknowledges the additional reimbursement the County Clinic would receive for serving as the originating site (i.e., the location of the Medicaid beneficiary when the service furnished via a telecommunications system occurs), there is no actual analysis of this facility fee and why it is not considered an increased cost. To be clear, the County Clinic does not provide the HIV preventative services to be delivered by the Provider via the telemedicine consultation, and therefore, would not have previously received any payments if and when the patient was referred to the Provider for an in-person consultation.
Again, it appears that the OIG is willing to prioritize the health benefits to patients over any secondary or tertiary benefits to the referring provider; especially when such subsequent benefits are unlikely to result in over-utilization and have the potential to decrease costs to federal health care programs.
Tags: donation, Fraud and Abuse, Telehealth, Telemedicine
Posted in Anti-kickback Statute, Compliance Programs, Safe Harbor Regulations, Stark Law and Self Referral, Telemedicine, Telemedicine and Telehealth | Comments Off on Telemedicine IT Donations and the Anti-kickback Statute – OIG Opinion 18-03
Tuesday, May 22nd, 2018
Substance Abuse Treatment Center Fraud Scheme Results in Guilty Plea
The Department of Justice recently announced the guilty plea of two individual alcohol and substance abuse treatment center owners for their participation in what DOJ labeled a “multi-million dollar health care fraud and money laundering scheme.” The two individuals owned a licensed substance abuse service provider (or treatment center) offering clinical treatment services for persons suffering from alcohol and drug addiction. The treatment center also offered medication-based treatment for opioid addiction.
The government had accused the two owners of paying illegal kickbacks/bribes to “sober homes” in exchange for the referral of the sober homes’ insured residents to treatment program. The sober homes provided safe and drug-free residences for individuals suffering from drug and alcohol addiction. This made them a prime source of potential referrals to the treatment program.
The accusations against these defendants read like a laundry list of thinly veiled kickback schemes. Some of the specific accusations included:
- Providing funds used to purchase or rent several sober home properties under purchase agreements or leases that were in the names of other parties so as to disguise the source of funds.
- Paying remuneration for referrals in the form of free or reduced rent, insurance premium payments, and other benefits to individuals with insurance who agreed to reside at the sober homes and attend drug treatment.
- Using a separate entity to pay insurance premiums for treatment patients so that the treatment program could continue to bill the patients’ insurance companies for treatment expenses.
- Hiring a doctor to serve as the medical director who frequently pre-signed prescriptions that were used to dispense controlled substances.
- Continuing to employ the medical director after the doctor’s license was suspended.
- Failing to inform the Florida Department of Children and Families that it could not continue to operate when the treatment center lost the medical director.
- Submitting insurance claims that falsely stated that testing and treatment was medically necessary.
If the allegations made by the government are to be believed, the treatment center is an illustration of exactly what intentional fraud looks like. This was not a mistake. Rather, it appears that the defendants deliberately set up a system intended to generate referrals and providing financial benefits to individuals in a position to make or influence those referrals. In short, this is what health care fraud looks like.
Providers that we deal with go to great lengths just to make certain that they proactively look for potential risk areas and take affirmative and proactive actions to be certain that they are not making mistakes that could inadvertently result in an overpayment or imputed knowledge. A great deal of expense goes into assuring that these providers are in complete compliance. By contrast, cases like the one involving these treatment programs illustrate the very reason why well providers with the best of intentions find it necessary to look over their shoulders.
Tags: Anti-Kickback, Fraud, referral fees, Treatment program
Posted in Anti-kickback Statute, Compliance Programs, False Claims Act, Fraud and Abuse, Safe Harbor Regulations | Comments Off on Treatment Center Plead Guilty to Anti-kickback Statute Violations Involving Alcohol and Drug Addiction Treatment Centers
Friday, May 18th, 2018
Unnecessary Breast Cancer Testing Fraud Settlement
A company will pay around $2 million to settle allegations of making false claims to Medicare for Breast Cancer Index (BCI) tests that were alleged to be not reasonable and necessary for the diagnosis and treatment of breast cancer.
The government accused the company of knowingly promoting and performing BCI testing for breast cancer patients who had not been in remission for five years and who had not been taking tamoxifen. The government alleged that performing BCI testing under these circumstances was not reasonable and necessary based on published clinical trial data and clinical practice guidelines.
This case highlights the need to assure that there is clinical support for providing and billing for services. In this case, the government took the position that patients who did not meet certain criteria would not benefit from the BCI testing.
Tags: BCI testing, doj settlements, False Claims Act, Fraud and Abuse, medical necessity
Posted in Billing and Coding, Compliance Programs, False Claims Act, Fraud and Abuse | Comments Off on Fraud Allegation for Unnecessary Breast Cancer Index (BCI)Testing
Thursday, May 17th, 2018
Unnecessary Inpatient Admissions – Hospital Fraud Settlement.
An $18 million settlement was agreed by a hospital chain after allegations that claims were submitted to Medicare for patients who were admitted to an inpatient facility when they allegedly could have been treated on a less costly outpatient basis. The government alleged that the hospital system billed Medicare for short-stay, inpatient procedures that should have been billed on a less costly outpatient basis. The government also accused the hospital system of inflating reports to Medicare regarding the number of hours of outpatient observation care that was provided.
This is a fairly typical case where the allegation involved billing for services that were of a higher level than required by the patient. In effect, the excess services are deemed to be medically unnecessary. In this case, the services involved inpatient admissions that the government alleged could have been taken care of in a less costly outpatient setting.
A former employee was the whistleblower in the case and walks away with over $3.25 million from the settlement.
Tags: DOJ Settlement, False Claims Act, Fraud and Abuse, Hospital admissions, Unnecessary Admissions
Posted in Compliance Programs, False Claims Act, Fraud and Abuse, Hospital Issues, Self-Disclosure | Comments Off on Unnecessary Inpatient Admissions Results in Hospital DOJ Settlement
Wednesday, May 16th, 2018
Recent Fraud Settlements Emphasize Risk of Whisttleblowers
One of the reasons why compliance officers and health care attorneys read fraud settlements is to identify the issues that the government is focused on. The cases that the government decides to pursue are very indicative of the areas of fraud enforcement that they feel are important. These are not the only issues that should be considered, but government enforcement actions certainly tell us what types of arrangements the government considers important.
The misfortune of the defendants involved in these cases hold a potential learning experience for everyone else. Others have an opportunity to focus on their own operations to identify whether they are at risk in any of the areas involved in these cases.
An ancillary lesson that these settlements hold is that each was initially raised by a whistleblower. The False Claims Act gives whistleblowers a portion of the settlement in cases where the government decides to intervene. This in effect creates a universe of potential claimants that can include almost anyone with original knowledge of the alleged practice.
Common whistleblowers include former or disgruntled employees. It really does not matter of the employee is or was the worst employee in the world, they can still bring an action as a whistleblower. Not only are they protected by a host of laws, they can also profit greatly if the claim is eventually decided in their favor. Whistleblowers often receive awards in the millions of dollars. This makes the area ripe for plaintiff’s attorneys who often take these cases on a contingency fee basis. This makes it a relatively low-cost proposition for a whistleblower to bring a case forward, at least from the perspective of attorney fees.
Tags: compliance risks, fraud risk, Health Care Fraud, potential whistleblowers, whistleblower claims
Posted in Anti-kickback Statute, Compliance Programs, False Claims Act, Fraud and Abuse, Reimbursement, Safe Harbor Regulations, Self-Disclosure, Stark Law and Self Referral | Comments Off on Whistleblower Settlements Increase Compliance Risk for Providers
Tuesday, May 15th, 2018
Overprescribing Opioids Without Demonstrated Medical Justification.
A settlement was recently announced by the Department of Justice that symbolizes another use of fraud enforcement by the government to combat the opioid epidemic. Providers need to take notice of these enforcement actions as they indicate opioid related issues as significant compliance risk areas.
The government alleged that a chiropractor billed Medicare and a state Medicaid program improperly for painkillers, including Opioids. The case involved four managed pain clinics, all which were closed through the course of the case. The settlement also required a nurse practitioner to pay $32,000 and surrender her DEA registration to settle allegations that she violated the Controlled Substances Act.
The Department of Justice issued a press release announcing the settlement that directly comments on the opioid issues involved in the case, leaving no ambiguity about what the government is up to. The quotations are not part of the normal “canned” statements that are normally included in these settlements. Every indication is that the opioid related language might be adopted a standard form as the government focuses in on these cases.
“More Americans are dying because of drugs today than ever before—a trend that is being driven by opioids,” said Attorney General Jeff Sessions. “If we’re going to end this unprecedented drug crisis, which is claiming the lives of 64,000 Americans each year, doctors must stop overprescribing opioids and law enforcement must aggressively pursue those medical professionals who act in their own financial interests, at the expense of their patients’ best interests.”
The government alleged that the defendants prescribed painkillers and caused pharmacy claims to be submitted where there was no legitimate medical purpose for the prescriptions. Additionally, the government alleged that the clinics up-coded and billed Medicare for office visits that were not reimbursable at the levels sought. In a demonstration of the commitment that the government has in this area, the clinics were also accused of billing for nurse practitioner services that were provided without the required collaboration arrangement in place.
The case was initially brought forward by a former office manager turned whistleblower who is set to earn $246,500 under the settlement.
Tags: False Claims Act, Fraud and Abuse, Opioid Epidemic, Opioid Prescribing, Prescription Enforcement
Posted in Compliance Programs, DEA Registration Issues, False Claims Act, Fraud and Abuse, Self-Disclosure | Comments Off on Opioid Prescribing Results in Medicare Fraud Claim
Tuesday, May 1st, 2018
Office Inspector General Launches New Compliance Resource Portal
by John H. Fisher, II, JD, CHC, CCEP
At a recent Health Care Compliance Association (HCCA) compliance institute, the Office of Inspector General announced it had launched a new resource portal focused on compliance issues. A trip to the OIG’s web site, and sure enough, there is a brand spankin’ new compliance portal. You can check out the portal at OIG Portal.
On first brush through the portal, it appears most of the items that are accessible already existed prior to the launch of the portal. The portal creates some organization that did not previously exist to guide providers to various compliance resources the OIG has made available.
Contents Listing of the OIG Compliance Portal
- Toolkits
- Provider Compliance Resource and Training
- Advisory opinions
- Voluntary Compliance and Exclusions Resources
- Special Fraud Alerts, Other Guidance, and Safe Harbors
- Resources for Health Care Boards
- Resources for Physicians
- Accountable Care Organizations
This is a site that compliance officers will want to have bookmarked in their browser. We are likely to see new developments in compliance posted on the portal. For example, it already references a toolkit on identification of opioid misuse risk will be coming soon to the portal.
When you get a chance, check out the new OIG resource and the tools that are available on the site. It is definitely something with which people in compliance should have familiarity. As usual, if you have any questions regarding compliance or other health care legal issues, please don’t hesitate to contact your Ruder Ware health care attorney.
Tags: Compliance Program Issues, Compliance Resources, Office of Inspector General, OIG COmpliance, OIG Compliance Site, OIG Portal
Posted in Billing and Coding, Compliance Programs, False Claims Act, Fraud and Abuse, HIPAA Health Information privacy, Nursing Facilities, OIG Annual Work Plan, Physicians and Group Practices, Safe Harbor Regulations, Self-Disclosure, Stark Law and Self Referral | Comments Off on Health Care Compliance Resource Portal Launched by OIG
Tuesday, May 1st, 2018
Green Bay Health Care Lawyer – Opening Office in Green Bay Wisconsin
I just wanted to let readers of our health care blog know that Ruder Ware will be opening a Green Bay office and that three Green Bay attorneys will be joining our firm. This will provide us with a presence in the Green Bay/Appleton Markets that will enhance our community presence and enable us to better serve our client in eastern Wisconsin. Our health care and compliance practice with be greatly enhanced as a result of this move.
This move will provide a local platform through which we can better serve our health care clients.
Health Care Law Practice – Green Bay Health Lawyers Ruder Ware
Ruder Ware has a long history of representing health care clients. The firm recognizes that the highly regulated and complex nature of the industry demands the attention of a team of attorneys who, as a group, monitor constantly evolving laws and regulations and their impact on our health care clients. At Ruder Ware, we offer a full-service solution to clients as our focus team consists of health care, business, employment, and litigation attorneys with knowledge of the health care industry. As a result, we are able to take best practices from other industries and apply them to the health care industry, thereby increasing the ability to respond promptly to the rapidly changing health care environment.
Members of the focus team have served on the governing bodies of various health care organizations. This service has provided our attorneys with the opportunity to counsel the health care community.
Our dedicated team of attorneys represents health care providers in various matters including:
Health Care Business Transactions and Corporate Law
Our attorneys have substantial expertise representing various health care providers such as:
Below is the official press release:
Media Contact:
Jamie Schaefer
COO
Ruder Ware, L.L.S.C.
P: 715.845.4336
E: jschaefer@ruderware.com
For Immediate Release
Attorneys Ronald Metzler, Christopher Pahl, and Chad Levanetz to join
Ruder Ware at its new Green Bay Office
WAUSAU, WI – April 27, 2018 – Ruder Ware is pleased to announce the opening of its Green Bay office and that Attorneys Ronald Metzler, Christopher Pahl, and Chad Levanetz will be joining the firm. The new office will be located at 222 Cherry Street, Green Bay, Wisconsin, which is the current location of Metzler, Timm, Treleven, S.C.
Attorney Ron Metzler – Having practiced law for over 30 years, Ron is a well-respected and well-known commercial attorney with close ties to the banking industry.
Attorney Chris Pahl – With his strong ties to the Green Bay community, Chris has built his practice around real estate development and condominium law as well as commercial transactions and estate planning.
Attorney Chad Levanetz – A seasoned litigation attorney, Chad counsels clients in the areas of real estate, construction, and general business disputes.
Stew Etten, Ruder Ware managing partner, stated, “Ruder Ware is always looking for outstanding attorneys to join our firm. With the opportunity to add Attorneys Metzler, Pahl, and Levanetz, the time was right to open a Green Bay office. We’re very excited to have attorneys of their caliber join our team of professionals.”
About Ruder Ware
Founded in 1920, Ruder Ware is the largest law firm headquartered north of Madison. With offices in Wausau, Eau Claire, and Green Bay over 40 attorneys provide legal and business advice to clients with operations of all sizes. Areas of practice include: Employment, Benefits & Labor Relations, Litigation & Dispute Resolution, Business Transactions, Trusts & Estates, and Fiduciary Services. Ruder Ware, Business Attorneys for Business Success. www.ruderware.com
Media Contact:
Jamie Schaefer
COO
Ruder Ware, L.L.S.C.
P: 715.845.4336
E: jschaefer@ruderware.com
Posted in Accountable Care Organizations (ACO), Ambulatory Surgery Centers, Anesthesia Issues, Anti-kickback Statute, Antitrust Law- Health Care, Behavioral Health Law, Billing and Coding, Change Of Ownership, Clinical Integration, Clinical Laboratory, Compliance Programs, Credentialing, DEA Registration Issues, Durable Medical Equipment, Electronic Health Information, Emergency Services EMTALA, False Claims Act, Fraud and Abuse, Game Still On, Health Care Governance, Health Care Reform, Health Care Twitter Posts, Health Law Practice, HIPAA Health Information privacy, Home Health Agencies, Hospice Legal Issues, Hospital Governance, Hospital Issues, Joint Commission JCAHO Issues, Long Term Care, Managed Care Compliance, Medicare Reimbursement Rules, Mergers and Acquisitions, NPDB Reporting, Nursing Facilities, OIG Annual Work Plan, Peer Review, Physician Employment Issues, Physician-Hospital Organizations, Physicians and Group Practices, Provider Integration, Radiology and Imaging, Reimbursement, Safe Harbor Regulations, Self-Disclosure, Shared Savings Program, Stark Law and Self Referral, Telemedicine, Telemedicine and Telehealth, Uncategorized | Comments Off on Health Law Firm Opens Green Bay Office
Tuesday, March 13th, 2018
Physician Revises Faxing Procedures to Safeguard PHI After Faxing PHI to Employer by Mistake
A medical office recently settled with OCR after it allegedly disclosed a patient’s HIV status when the office mistakenly faxed medical records to the patient’s place of employment instead of to the patient’s new health care provider. The employee responsible for the disclosure received a written disciplinary warning, and both the employee and the physician apologized to the patient. To resolve this matter, OCR also required the practice to revise the office’s fax cover page to underscore a confidential communication for the intended recipient. The office informed all its employees of the incident and counseled staff on proper faxing procedures.
Two things pop about about this instance. First, this was clearly a privacy violation. The patient’s protected health information, which incidentally revealed his or her HIV status, we sent to the employer. Secondly, it was evident from the facts that this was a mistake. We aren’t told exactly how this mistake was made. Was the fax number written down in the wrong box on the patient’s records? Did the employee who faxed the records put the incorrect number on the fax cover sheet? We may never know. But this does raise the importance of being precise at all stages of the patient encounter to assure that no inadvertent violations occur. Care you should be taken when information about the patient is initially entered into the system. Individuals at all levels who may be responsible for transmitting PHI must be deliberate about their actions. How many people have called or faxed something to the wrong person before? How many people have written down the wrong telephone or fax number before? Everyone?
This OCR settlement just illustrates that sometimes these small errors can have big implications. It does not appear to have been any significant fines or loss of employment in this situation. But we cannot downplay the potential embarrassment or other negative consequences of mistakes like these. It is one thing to text your friend Bob rather than your friend Bobbie, and weirdly from Bob’s perspective say how wonderful last night was and how you can’t wait to see him again. Telling a patient’s employer about their health condition can have consequences that are much harder to laugh off.
Tags: faxing records, hipaa settlements, hipaa violation, OCR Settlement, wrong recipient
Posted in Compliance Programs, Electronic Health Information, HIPAA Health Information privacy, Uncategorized | Comments Off on Faxing Patient Health Information to Wrong Number – Compliance Risk Area