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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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In addition to regularly featured columns such as HIPAA, auditing and monitoring, and the anti-kickback statute, the July-August 2008 issue of the Journal of Health Care Compliance includes the following articles:

• “New Enforcement Powers and Incentives Aimed at Medicaid Fraud Enacted by the DRA,” written by Connie Raffa, JD, LLM, discusses the requirements mandated by the Deficit Reduction Act that have enhanced Medicaid enforcement actions and suggest ways a Medicaid provider can protect itself.
• “Corporate Criminal Liability and Cooperation – What Does the Government Expect Now?” written by Gabriel L. Imperato, examines the Sarbanes-Oxley Act, Sentencing Guideline amendments, and the Thompson and McNulty Memoranda issued by the Department of Justice.
• “Compliance Considerations in Working with Third-Party Billing Companies,” written by Karen L. Collier, focuses on important issues providers should consider when outsourcing its billing and coding functions, including contracting and compliance issues.
• “Paying Twice: Medicare Claims for Same-Day Readmissions,” written by Nancy C. McCabe and Anita J. Bhatia, provides an in-depth analysis of related versus unrelated admission and the impact on reimbursement.

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Panelists at a recent Senate Finance Committee hearing agreed that health information technology can not only help reduce health care costs and improve quality, but also can improve the way the government pays for Medicare services. “Many observers believe that widespread use of [information technology (IT)] would improve health care quality and efficiency,” Senate Finance Committee Chairman Max Baucus (D-Mont.) said at a July 17, 2008, hearing to explore health care reform options. Ranking member Charles Grassley (R-Iowa) noted the systems are expensive to install. “While it's clear that electronic patient records will improve efficient health care, the economics have not proven attractive to doctors. We need to think about how to make adoption of electronic records more attractive to those who will use them,” Grassley added. Project Hope Senior Fellow Gail Wilensky suggested that a federally-funded clinical research center could produce information on comparative clinical effectiveness based on data gleaned from electronic health records. Congressional Budget Office Director Peter Orszag said that a significantly expanded comparative effectiveness effort, combined with changes in financial incentives, “holds substantial potential” for reducing health care costs and improving the quality. CCH Washington Bureau, July 17, 2008. Full Story

HHS has entered into a Resolution Agreement with Seattle-based Providence Health & Services (Providence) to settle potential violations of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy and Security Rules. This is the first time HHS has required a Resolution Agreement from a covered entity. Under the agreement, Providence will pay $100,000 and implement a detailed Corrective Action Plan to ensure that it will appropriately safeguard identifiable electronic patient information against theft or loss. Providence's cooperation with the Office of Civil Rights and CMS allowed HHS to resolve this case without the imposition of civil money penalties. HHS Press Release, July 17, 2008. Full Story

Since the compliance date of April 14, 2003, HHS' Office of Civil Rights (OCR) has received over 37,223 complaints under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy Rule, resolving over eighty percent of these complaints. HHS has investigated and resolved over 6,648 cases by requiring changes in privacy practices and other corrective actions by the covered entities. In another 3,290 cases, HHS investigations found no violation. In the balance of resolved cases (20,644), HHS found that the complaint was ineligible for enforcement under the Privacy Rule because: (1) OCR lacked jurisdiction under HIPAA; (2) the complaint was untimely, withdrawn, or not pursued by the filer; or (3) the activity described did not violate the Rule. As of June 30, 2008, OCR has made over 436 referrals to the Department of Justice for criminal investigation involving knowing disclosure or obtaining of protected health information in violation of the HIPAA Privacy Rule. In addition, over 250 referrals have been made to CMS for investigation of potential violation of the HIPAA Security Rule. HHS Press Release, June 30, 2008. Full Story

The Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule permits the use and disclosure of protected health information (PHI) to treat patients; identify, locate, and notify family members and certain other individuals of a patient's location, general condition or death; obtain the services of disaster relief agencies such as the American Red Cross; carry out public health activities and prevent or lessen serious and imminent threats to health or safety, Chana Feinberg, Health Information Management director at Unity Health System in Rochester, New York explained during a teleconference sponsored by the American Health Information Management Association. Questions regarding the use and disclosure of PHI arise in situations involving adoptions, minor children, psychiatric patients, and cultural issues, according to Aviva Halpert, chief HIPAA officer at Mt. Sinai Medical Center in New York City. CCH Washington Bureau, July 9, 2008. Full Story

The privacy rule of the Health Insurance Portability and Accountability Act (HIPAA) is causing a negative impact on the advance of biomedical research and the search for treatments, according to a report by the Association of Academic Health Centers (AAHC) entitled “HIPAA Creating Barriers to Research and Discovery.” The AAHC report describes the unintended, disruptive consequences of the privacy rule, including confusion for patients, misinterpretation by research participants, barriers to patient recruitment, and burdensome administrative procedures that increase research costs. AAHC Press Release, June 16, 2008. Full Story

By a 402-17 vote on June 25, 2008, the House of Representatives overwhelmingly passed the “ADA Amendment Act” (H.R. 3195), which clarifies the definition of disability and could potentially grant millions of workers protections under the Americans with Disabilities Act (ADA). Lawmakers say the bill, supported by a broad coalition of employer groups and disability rights advocates, is necessary to reverse a series of Supreme Court decisions that have narrowed the definition of who is covered under the Act. The legislation clarifies the definition of “disability,” containing a nonexhaustive list of examples of what it means to be substantially limited in a major life activity. The bill defines “substantially limits” as “materially restricts,” rather than the Supreme Court’s more restrictive interpretation. CCH Washington Bureau, June 25, 2008. Full Story

Reflecting the continuing commitment of America’s pharmaceutical research and biotechnology companies to pursue policies and practices that best serve the needs of patients and the healthcare community, the Pharmaceutical Research and Manufacturers of America (PhRMA) Board of Directors has adopted measures to enhance the PhRMA Code on Interactions with Healthcare Professionals. The newly revised PhRMA Code, which builds on improvements made in the previous 2002 version, is part of an ongoing effort to ensure that pharmaceutical marketing practices comply with the highest ethical standards. PhRMA press release, July 10, 2008. Full Story

The House Energy and Commerce Committee approved legislation by voice vote on July 23, 2008, to improve health information technology. The bill, entitled “Protecting Records, Optimizing Treatment, and Easing Communication through Healthcare Technology Act of 2008” (H.R. 6357), or the “PRO(TECH)T Act,” aims to strengthen the quality of health care, reduce medical errors and costs, and further protect the privacy and security of health information. The bill would require notification when protected health information is breached and extend federal privacy law to entities that do business with providers, such as quality review organizations and newer entities that store and manage a provider’s electronic health information allowing the federal government to bring enforcement actions against bad actors. CCH Washington Bureau, July 24, 2008. Full Story

Amerigroup Corporation announced a comprehensive settlement agreement in principle that would conclude its civil qui tam litigation related to certain marketing practices of its former Illinois health plan. In 2007, a judgment against Amerigroup and its Illinois subsidiary resulted in a civil amount of approximately $334 million plus fees. Under the terms of the proposed settlement, Amerigroup will pay $225 million to the United States and the State of Illinois, plus approximately $9 million in legal fees, and will not admit any wrongdoing. Additionally, in connection with the settlement, the company would enter into a corporate integrity agreement with the HHS Office of Inspector General. Amerigroup Press Release, July 22, 2008. Full Story

The responsibility for measuring and preventing improper payments to acute inpatient prospective payment (IPPS) hospitals and long term care hospitals has been transferred from quality improvement organizations (QIOs) to fiscal intermediaries, Medicare administrative contractors, and Comprehensive Error Rate Testing contractors. This change will allow the QIOs to concentrate on improving patient quality of care and maintaining quality improvement and provider assistance efforts. CMS Fact Sheet, July 9, 2008. Full Story

An Analysis of the New Schedule H (IRS Form 990) and Proposed Instructions--Are Hospitals Ready for Increased Disclosures? Part II

by Albert Y. Lin, LLM, CPA, Health Care Compliance Advisory Board Member

To prepare the compliance officer for increased disclosure requirements in the revised Form 990 (U.S. Return of Exempt Organizations) Part I of this Article introduced the new Schedule H (Hospitals) that tax-exempt hospitals and hospital systems will need to file beginning with the 2008 tax year (with only a part required for 2008 and the full Schedule H to be completed for the 2009 tax year). It focused on the detailed charity care and community "cost" reporting requirements, and guides the compliance officer through a discussion of the Schedule H itself and the accompanying Draft Instructions and Worksheets. Part II of this Article covers the remainder of Schedule H, which includes reporting of bad debt, Medicare information, and collection practices, as well as management company, joint venture, and facility disclosures. Full Story