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CCH® Health Care Compliance Integrated Library
The Health Care Compliance Integrated Library delivers the latest information on health law. The Library includes seven invaluable titles:

• Civil False Claims and Qui Tam Actions - An essential tool for bringing or defending Qui Tam action.
• Clinical Research Compliance Manual: An Administrative Guide - Essential guidance on the laws and regulations affecting clinical research and trials.
• Defending and Preventing Health Care Fraud and Abuse Cases: An Attorney's Guide - Clear, expert guidance on protecting against charges of health care fraud and abuse.
• Health Care Fraud and Abuse Compliance Manual - Giving health care providers a clear perspective on fraud and abuse laws, written in plain-language.
• Health Law and Compliance Update - Find the latest information on emerging issues. Each section is authored by an expert in the area and includes in-depth analysis of the latest health law and compliance issues.
• Hospital Contracts Manual - Expert, current know-how in dealing with numerous hospital contract scenarios.
• Hospital Law Manual - Health Law expertise covering treatment and payment issues in the delivery of health care services.

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The Office of Inspector General (OIG) found that public disclosure of information about adverse events was limited, according to its review of 17 state adverse event report systems, eight Patient Safety Organizations overseen by the Agency for Healthcare Research and Quality (AHRQ), and the Centers for Medicare & Medicaid Services (CMS). Varying extent of disclosure among state systems. Among the entities reviewed, seven state systems disclosed more extensive information about the causes of adverse events and prevention strategies than the other state systems. Three other state systems disclosed less extensive information about the causes of the adverse events and prevention strategies. AHRQ. AHRQ anticipates creating the Network of Patient Safety Databases (NPSD) to provide an evidence-based management resource for providers, patient safety organizations, and other entities. Patient Safety Organizations (PSOs) will submit adverse event information received from hospitals to the NPSD, which will allow AHRQ to receive and publicly disclose non-identifiable adverse event information. Once the NPSD is operational, the Patient Safety Act requires that the data be used to analyze national and regional statistics, including trends and patterns of reported adverse events, and to generate two public reports on: (1) effective strategies for reducing medical errors and increasing patient safety, and (2) trend analysis results. The initial NPSD data is estimated to be available for analysis and disclosure in early 2011. CMS. CMS has selected ten categories of conditions for the Medicare hospital-acquired condition policy, and presently denies hospitals higher payment for Medicare admissions complicated by the ten conditions. CMS is considering posting the incidence of hospital-acquired conditions on its Hospital Compare Website, which presently includes other quality measures about hospitals. Medicare claims data, however, lack information about the causes of hospital-acquired conditions or prevention strategies. Patient privacy. Every entity reviewed by the OIG had patient privacy protections in place that varied in scope. OIG Report, No. OEI-06-09-00360, Jan. 5, 2010

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A Department Appeals Board (DAB) order upholding the finding of an immediate jeopardy level violation and the imposition of $3,500 per day civil money penalty (CMP) against a skilled nursing facility (SNF) was vacated by the Eighth Circuit Court of Appeals because the DAB's finding was based on pure speculation and not supported by substantial evidence contained in the administrative record. The case focuses on the care provided to an 86-year-old female resident in declining health who ultimately died. The Eight Circuit found that the state agency and CMS based their immediate jeopardy level charges on six interrelated deficiencies, not based on the failure to investigate bruises observed during three-day period prior to transfer to the hospital emergency room. According to the court, the administrative law judge and the DAB, in effect, convicted the SNF based on a violation not charged, yet the DAB made no fact-specific analysis of the immediate jeopardy issue and cited no facts raising an inference that the SNF's failure to investigate a doctor's statement more promptly or thoroughly increased the risk of abuse. As a result, the DAB's order of immediate jeopardy and imposition CMPs was vacated. HHS was also directed to expunge all references to findings of immediate jeopardy level noncompliance by the SNF in HHS and CMS records that are accessible by any means to the public and ensure that the state survey agency does the same. Grace Healthcare of Benton v. CMS, 8th Cir., Dec. 21, 2009, Health Care Compliance Reporter, ¶800,801

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The evidence in a qui tam action against a medical supplier for submitting improperly coded bills to Medicare and Medicaid showed confusion existed over the proper billing codes and thereby created a jury question as to whether the supplier acted "knowingly" or with "reckless disregard of the truth or falsity" of the claims submitted. The government's motion for summary judgment on their improper coding claims was denied. A second allegation that the supplier altered prescriptions to call for a more expensive back brace in order to receive higher reimbursement was also a question for the jury to decide with regard to all of the government claims except a single count to which the supplier previously pled guilty to in a criminal proceeding. Summary judgment was granted to the government on the civil count that corresponded to the criminal count the supplier's president pled to. The remaining civil claims must be considered by the jury at trial. The court also found that the corporate president's wife was not liable under the guilty plea of the corporation because it was not certain whether she was ever an officer of the corporation and all charges against her had been dropped in the criminal action. Summary judgment against the president's wife was denied. U.S. ex. rel. Schaefer v. Conti Medical Concepts, Inc., et. al., W.D. Ky., Dec. 17, 2009, Health Care Compliance Reporter, ¶800,795

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The effect of the downturn in economy on compliance budgets and staffing in 2009, and the compliance professional’s expectations for 2010, are the subject of a joint survey of The Society of Corporate Compliance and Ethics (SCCE) and the Health Care Compliance Association (HCCA). The joint survey made the following findings: 2009 budgets and staffing. By the end of the 2009, 26 percent of compliance professionals reported that their budget had increased and 27 percent reported that their budgets had decreased. 2010 expectations. For 2010, approximately seven percent of survey respondents anticipate their budgets will increase a great deal, and 26 percent expect a marginal increase. Job security. When respondents were asked if they feel that their job is more at risk than others in their organization, 18 percent felt that their job is somewhat more at risk and seven percent felt that their job was much more at risk. Management's perspective. Twenty-three percent of the compliance professionals surveyed reported that management sees compliance and ethics as a very positive asset in helping the organization through the current economic conditions. Perceived risk of failure. Fifty-four percent of respondents anticipated that the current economy somewhat increases the risk of compliance and ethics failures and 33 percent of respondents anticipated that the economy greatly increased the risk of failures. Warning. The joint HCCA/SCCE report concludes that companies looking to cut budgets may risk raising a red flag in the eyes of prosecutors and the courts; and may find themselves having to explain why they are cutting compliance spending while competitors are maintaining or increasing their budgets. HCCA/SCCE Joint Survey; The Economy, Compliance, and Ethics; Dec. 2009

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A doctor was not required to produce a number of documents on the grounds that they were protected by the state's peer review privilege. The peer review privilege precluded discovery of documents or any other data generated by any peer review committee engaging in peer review activities. A peer review committee consists of one or more persons who act as a committee of a specified entity, such as a group medical practice. Peer review activities include activities that relate to matters affecting a health professional's membership on the staff, matters affecting employment, and evaluation of the qualifications, competency or performance of any health professional. The two individuals who had brought suit against the doctor sought to compel a number of documents from the group medical practice that employed the doctor, including: minutes of the quality management committee (QMC) that discuss the doctor's patients; documents reviewed by the QMC concerning the doctor; documents relating to the board of director's meetings that discuss the doctor's employment; and information provided to the state medical association and state board of medical and osteopathic examiners. The QMC, board of directors, state medical association and state board of medical and osteopathic examiners fell under the definition of "peer review committee" given that the matters at issue related to the doctor's employment, competency, performance and qualification as a health professional on the staff of the group medical practice. Accordingly, they were barred by the state's peer review privilege. The only documents that were not barred by the privilege were those relating to the doctor's application for insurance because the insurer did not engage in any peer review activity when reviewing the doctor's application. Uhing v. Callahan, D. N.D., Jan. 4, 2010, Health Care Compliance Reporter, ¶800,814

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