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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 availability of an expanded and enhanced Common Formats Version 1.0 and the process for its continued development and refinement have been announced by the Agency for Healthcare Research and Quality (AHRQ). As authorized by HHS, the AHRQ coordinates the development of a set of common definitions and reporting formats (Common Formats) that allow healthcare providers to voluntarily collect and submit standardized information regarding patient safety events. The initial release of the formats, Version 0.1 Beta, was announced in the Federal Register on August 29, 2008 (73 FR 50974-50976). The Common Formats can be accessed electronically at http://www.pso.ahrq.gov/index.html. Reporting framework. The Patient Safety Act (42 U.S.C. §299b-21 to b-26) and Patient Safety Rule (42 C.F.R. Part 3) establish a framework by which doctors, hospitals, and other healthcare providers may voluntarily report information regarding patient safety events and quality of care. Information that is assembled and developed by providers for reporting to patient safety organizations (PSOs) and the information received and analyzed by PSOs—called “patient safety work product”—is privileged and confidential. Patient safety work product is used to identify events, patterns of care, and unsafe conditions that increase risks and hazards to patients. Common Formats. AHRQ's Common Formats include: (1) descriptions of patient safety events and unsafe conditions to be reported, (2) delineation of data elements to be collected for specific types of events, (3) specifications for patient safety population reports, (4) technical specifications for electronic data collection and reporting, and (5) a user's guide. Scope of Common Formats. The scope of Common Formats applies to all patient safety concerns, including: (1) incidents—patient safety events that reached the patient, whether or not there was harm, (2) near misses or close calls—patient safety events that did not reach the patient, and (3) unsafe conditions—circumstances that increase the probability of a patient safety event. The AHRQ welcomes industry feedback. Information on the feedback process can be obtained at http://www.pso.ahrq.gov/index.html. AHRQ Notice, 74 FR 45457, Sept. 2, 2009
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Eighty-two percent of hospice claims for beneficiaries in nursing facilities in 2006 did not meet at least one Medicare coverage requirement, according to the Office of Inspector General (OIG). In 2006, Medicare paid approximately $1.8 billion for these claims. Eighty-one percent of the claims did not meet at least one Medicare coverage requirement relating to election statements, plans of care, services or certifications of terminal illness, and an additional one percent of the claims were undocumented (i.e., the hospices did not submit any records to support the claims, as required). Election statements. Thirty-three percent of hospice claims did not meet election requirements. There were no election statements for four percent of the hospice claims. For another 29 percent of the claims, the election statements did not comply with one or more regulations. In most instances, the election statements did not explain that hospice care was palliative, rather than curative, or explain that the beneficiaries waived Medicare coverage of certain services related to their terminal illnesses. Plan of Care. Sixty-three percent of the claims did not meet plan of care requirements. The hospices did not establish plans of care for beneficiaries in one percent of the claims. For another 62 percent of the claims, the plans did not meet at least one federal requirement. These plans of care were not established by interdisciplinary groups; did not include necessary components, such as detailed descriptions of scope and frequency of services; or did not specify intervals for review, as required. Certification of terminal illness. In four percent of hospice claims, the certifications were missing or did not meet one or more federal requirements. Some deficiencies included: failure to specify that the individual's prognosis was for a life expectancy of six months or less if the terminal illness ran its normal course; absence of supporting clinical information or other documentation in the medical record; or absence of physician signatures. The OIG recommended that CMS: (1) educate hospices about coverage requirements and their importance in ensuring quality of care; (2) provide tools and guidance to hospices to help them meet the coverage requirements; and (3) strengthen its monitoring practices regarding hospice claims. CMS concurred with all of the recommendations. OIG Report, No. OEI-02-06-00221, Sept. 8, 2009
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The U.S. District Court for the Eastern District of Pennsylvania properly ruled in favor of several hospitals and doctors who allegedly violated the Emergency Medical Treatment and Active Labor Act (EMTALA), 42 U.S.C. § 1395dd, by failing to stabilize and inappropriately transferring a patient, when the patient in question did not present herself in an emergent state and was not in an emergent state until she began to undergo monitoring at the primary hospital. Excluded patients. EMTALA's requirements are triggered when an individual comes to the emergency department, 42 C.F.R. § 489.24(a)(1). Such an individual can only come to the emergency department if that person is not already a patient of the hospital. Under 42 C.F.R. § 489.24(b), a patient is defined as an individual who has begun to receive outpatient services as part of an encounter . . . other than an encounter that the hospital is obligated by this section to provide. EMTALA does not apply to outpatients, even if during an outpatient encounter, they are later found to have an emergency medical condition and are transported to the hospital's emergency department. The Third Circuit Court of Appeals held that, contrary to the parents' assertion, the mother did not come to the hospital with an emergency medical condition. The mother was not in an emergent state until after she began the monitoring at the primary hospital and her condition quickly changed. Neither her previous complaints of discomfort nor her high-risk pregnancy amounted to an emergency under EMTALA. The circumstances failed to trigger EMTALA, and therefore precluded the parents' EMTALA claim. Actual knowledge requirement. The parents were moreover required to prove that: (1) the mother had an emergency medical condition, (2) the hospital actually knew of the condition, and (3) the patient was not stabilized before being transferred. The parents' EMTALA claim failed because they did not satisfy the requirement of actual knowledge. For example, there was no evidence that any of the hospital staff at the perinatal facility actually knew that the mother's condition was an emergency before directing her to her primary hospital for further monitoring. The Third Circuit accordingly held that the parents' EMTALA claim was properly dismissed. Torretti v. Main Line Hospitals, Inc., 3rd Cir., Sept. 2, 2009, Health Care Compliance Reporter, ¶800,724
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