Third-Party Payments: Did you know that the Department of Justice has settled charges brought against an Ohio health care insurer's practice of requiring hospitals not to charge lower rates to other payors? The government objected to the use of such a "most favorable rate" clause. The payor has agreed to drop enforcement of the offending clause.
Nursing Home Sanctions: Did you know that a U.S. False Claims Act case against a Maryland nursing facility has been partially settled? The first-of-a-kind local action was based on allegations of substandard care, and has resulted in an agreed-upon "consent preliminary injunction" requiring changes in the facility's operations and management.
PRO Activities: Did you know that a national coalition of health care providers is attempting to influence HCFA's proposal for peer review organizations to become more involved in reviewing for billing errors? The coalition is seeking a less punitive role for the PROs to guarantee physician cooperation with PRO activities and goals.
Hospital Outpatient Rates: Did you know that the Office of the Inspector General has objected to HCFA's proposed formula for prospective hospital outpatient reimbursement? The OIG believes that the proposed rates will be excessive, because they are based on existing rates which include "unallowed costs" and "improper payments."
Practitioner Data Bank: Did you know that the federal government has attempted to close a "loophole" in reporting malpractice actions? Proposed regulations would require reporting of those practitioners who provided the medical care subject to the malpractice claim or action, thus preventing providers from avoiding reporting by obtaining dismissal of their status as defendants in an ongoing case.