The Medical Center at Bowling Green (KY) is notifying 5,418 patients of a breach of personal health information after the theft of a computer hard drive from the hospital's mammography unit. The hard drive contained data on patients who underwent bone density testing at The Medical Center between 1997 and 2009.
"We have no reason at this point to believe the device was stolen for the information on it or that any personal information has been released or used," the hospital said in a statement posted on its Web site.
The personal information on the hard drive was not encrypted, the hospital said.
The Medical Center staff discovered the theft on April 1, launched an internal investigation, and reported the theft to local police. Information in the hard drive includes each patient's full name, date of birth, address, medical record number, and physician name. Some patients' records also include Social Security numbers, weight, height, and menopause age.
"As a result of this breach, steps are underway to further strengthen the security of patient information," the hospital statement read. "We will now archive data to a secure network, which will allow us to eliminate the need for use of a hard drive like the one that was stolen. Additionally, we will ensure that we do not have any other equipment configurations that utilize a portable hard drive containing non-encrypted data."
The hospital is urging affected patients to monitor accounts and bank statements each month and check credit reports on a regular basis, and has notified the Department of Health and Human Services about the breach.
What can your hospital learn about safety from a coal mine? Quite a bit, actually.
The New York Timesrecently ran an in-depth piece comparing the allegedly checkered safety record and procedures at the now-infamous Upper Big Branch Mine—the Massey Energy Co. coal mine in Montcoal, WV, where 29 men lost their lives following an April 5 explosion—against the E3-1 coal mine in Hazard, KY, that is run by TECO Coal Corp., a company with an impressive safety record. Both mines are nonunion, but the Times report suggests that that is nearly all they have in common.
Despite emitting 25% more methane gas than the Upper Big Branch Mine, for example, E3-1 hasn't had a fatality since it opened in July 2004, the Times reports, nor has it accumulated anywhere near the dozens of safety citations the Upper Big Branch has received. TECO, the Times reports, routinely surpasses minimum state and federal safety standards in critical safety areas like mineshaft ventilation and air quality, and worker emergency training.
Safety inspections are constant at E3-1, especially around shift changes. Workers are encouraged to speak out against safety hazards, and managers and foremen are held accountable for ensuring that equipment is working and safety procedures are followed. If there is a breakdown in safety procedures, someone gets fired.
TECO miners and managers spoke openly and on the record with the Times and said they were satisfied with their training and the safety precautions taken on their part. TECO said it rewards miners who report safety issues, and also provides an 800 number for anonymous complaints.
Massey declined to comment in the Times piece, but the Richmond, VA-based energy company disputed the allegations after the article ran.
"Clearly, something went wrong at Upper Big Branch. But we simply don't yet know what it was," Massey's statement read in part. "If there was improper conduct regarding operations and safety, there will be accountability. What we do know is this: accusations that Massey Energy is indifferent to safety could not be more wrong. Our company puts the safety of its members first—and always first."
Nice slogan: Safety First! Who could argue with that! Sadly, with 29 lives lost, it's no longer about slogans or safety. It's damage control.
Of course, the goal of a good safety program is measureable outcomes, not catchy phrases. In coal mines, safety is measured by quantifiable numbers such as a lack of fatalities, or a reduction in workplace injuries and job-related chronic diseases such as black lung. In hospitals, safety is measured in the reduction of hospital-acquired infections, medication errors, and other preventable mistakes that the Institute of Medicine once said needlessly kill about 100,000 patients each year.
Good hospitals, like good coal mines, have a deeply imbued culture of safety that goes beyond mere words. Safety culture never rests. It always strives to protect workers–and patients—from dangerous conditions. It empowers employees to speak out against hazardous conditions or practices without fear of retribution. Good managers at coal mines—and hospitals—understand that lives are at stake.
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Independence Blue Cross will offer $47 million in pay raises for primary care physicians in its southeastern Pennsylvania provider network, including $33 million to incentivize better patient outcomes, the Philadelphia-based health insurer announced today.
IBC said the added money will allow the 1,800 primary care physicians in that network to double their incentive earnings over last year's program by providing better care to IBC's commercial and Medicare Advantage HMO and Point-of Service members. The changes in reimbursement will attract and retain high-performing primary care physicians, IBC added. At the same time, IBC said it is “modifying” reimbursements for costlier, episodic, specialty care services, which the insurer said can often be avoided with regular, effective preventive care.
"IBC is a strong advocate for changing the healthcare system to enhance the affordability and quality of healthcare," IBC President/CEO Joseph A. Frick said. "Real and sustainable healthcare reform includes collaborating with our physician and hospital partners by enhancing incentives for providing safer, higher quality, and more cost-effective care—rather than just more care. That's what these changes are all about and they demonstrate our commitment to help people stay well, and encourage better coordination of care when our members become ill."
Beginning July 1, IBC's compensation for primary care physicians will include three components:
Base reimbursement. IBC will raise pay to network primary care physicians by an average of 10%—the largest pay raise IBC has given in the last five years.
Incentives for improving clinical quality outcomes while improving patients' education and access to care. The Quality Incentive Payment System will reward primary care physicians who improve the quality of care compared to national standards of quality care through proper blood sugar testing, cholesterol screening, eye exams for diabetics, and other measures such as breast, cervical, and colorectal cancer screenings, childhood and adolescent immunizations, and asthma and cardiovascular management. The incentives reward physicians' performance on process measures and quality outcomes compared to peers in the same primary care specialties. The highest performing physicians get the highest reimbursements.
Incentives for managing medical costs. The supplemental money incentivizes physicians to improve care coordination, and to take the time to discuss with patients the risks and benefits of certain procedures or treatment, and to help patients understand the value of the treatment–for example, understanding the benefits of non-invasive, conventional treatment versus a diagnostic or invasive procedure.
Johnson & Johnson subsidiaries Ortho-McNeil Pharmaceutical LLC, and Ortho-McNeil-Janssen Pharmaceuticals Inc. will pay more than $81 million to resolve criminal and civil whistleblower allegations that they promoted the off-label use of the epilepsy drug Topamax, the Justice Department announced today.
In a separate whistleblower settlement also announced today, DOJ said Schwarz Pharma Inc. will pay $22 million to resolve False Claims Act allegations that the company didn’t tell the Centers for Medicare and Medicaid Services that two unapproved products did not qualify for federal reimbursements.
Ortho-McNeil will plead guilty to a misdemeanor and pay a $6.14 million criminal fine for the misbranding of Topamax in violation of the Food, Drug and Cosmetic Act. The Food and Drug Administration approved Topamax as an anti-epileptic drug, but not for psychiatric use.
The government alleged that Ortho-McNeil Pharmaceutical promoted Topamax for off-label psychiatric uses through a “Doctor-for-a-Day” program that hired outside physicians to visit other healthcare providers and encourage prescribing Topamax for unapproved uses.
Ortho-McNeil-Janssen will pay $75.4 million to resolve civil allegations that their off-label promotion of Topamax caused false claims to be submitted to government healthcare programs for psychiatric uses that were not reimbursable. The federal share is $50.6 million, and the state Medicaid share is $24.6 million. The whistleblowers will get more than $9 million from the federal share.
Ortho-McNeil-Janssen Pharmaceuticals will enter a corporate integrity agreement with the Office of Inspector General of the Department of Health and Human Services. The settlement with Schwarz, now a subsidiary of Belgium-based UCB S.A., resolves allegations that the company submitted false quarterly reports to the government about the drugs Deponit, a nitroglycerin skin patch, and Hyoscyamine Sulfate Extended Release, an antispasmodic medication for stomach, intestinal, and urinary tract disorders. Federal prosecutors said Schwarz misrepresented the regulatory status of both drugs and failed to advise CMS that these unapproved drugs did not qualify for coverage under federal healthcare programs.
The federal share of the settlement is $12.2 million, and the state Medicaid share is $9.7 million. Two whistleblowers in the settlement will get $1.8 million.
Democratic Sen. Dianne Feinstein of California called on WellPoint Inc. to drop plans for premium pay hikes of as much as 39% on policyholders in her state after the health insurer reported a Fiscal 2010 first quarter profit increase of 51%.
Indianapolis-based WellPoint reported a net income of $876.8 million, or $1.96 per share, with total revenues of $15.1 billion, as profits from its consumer segment increased by 49%, to $326 million. WellPoint credited the solid quarter on enrollment growth of 0.5% and lower benefit expenses, owing to the relatively mild flu season.
"We are pleased with our membership growth in the first quarter, which was higher than we anticipated. We have grown significantly in the National Accounts market this year, reflecting that large customers continue to be attracted to WellPoint's broad and cost-effective provider networks, leading products and initiatives, and reliable customer service," WellPoint CEO/ President Angela F. Braly said in the profits report.
Feinstein said in a media release that the profits were evidence that WellPoint is not hiking up rates on customers due to economic need, as the company claims, but as part of a coordinated strategy to drive up corporate profits. Feinstein noted that WellPoint's profit increase came two weeks after news reports revealed that Braly received a 51% increase in her compensation last year.
"At a time when so many Americans are struggling to make ends meet in a tough economy, WellPoint is reaping a 51% increase in profits while simultaneously raising premium rates on hardworking California families by up to 39%. This is unconscionable," Feinstein said. "WellPoint's actions are a textbook example of the profits-above-all-else Wall Street mentality that has caused major hardship for millions of average Americans. It's time to break the profit-hungry habit."
WellPoint Inc. is the parent company of Anthem Blue Cross of California, which announced plans in February—in the middle of the national debate on healthcare reform—to impose rate hikes of up to 39% on 800,000 policyholders. The company has twice delayed the rate hikes because of sharp criticism.
"I call on WellPoint to cancel its plans to increase premium rates on policyholders in California until the time when there is a national Health Insurance Rate Authority in place to review whether these rate hikes are justified—and to protect policyholders from unfair corporate greed," Feinstein said.
Feinstein has introduced the Health Insurance Rate Authority Act of 2010, which would empower Health and Human Services to review and reject unfair premium rate increases. Rep. Jan Schakowsky (D-IL) has introduced a companion bill in the House.
Nearly half—44%—of primary care physicians received no additional compensation for on-call coverage, according to the Medical Group Management Association’s Medical Directorship and On-Call Compensation Survey: 2010 Report Based on 2009 Data.
In addition, 49% of nonsurgical specialists who answered Englewood, CO-based MGMA’s survey reported no additional compensation for on-call coverage, while 72% of surgery specialists received additional on-call compensation. Most survey respondents said the compensation was in the form of a daily or annual stipend.
The daily rate of on-call physician compensation varied greatly among specialties. Family practitioners with and without OB/GYN earned $110 and $100, respectively, per day. Neurosurgeons earned $1,671 daily. Ophthalmologists earned $500 in additional compensation per day while general surgeons earned $905 and urologists earned $283. The holiday rate for general surgeons was $3,000, and family practitioners received $588 per day.
"For many privately owned physician practices, the trend toward payment for on-call coverage is a positive one. Hospitals are faced with staff issues regarding who should receive pay and why, and are frequently called upon to develop justifiable rationale to support their decisions," said Kenneth T. Hertz, principal, MGMA HealthCare Consulting Group. "At the same time, as the trend toward physician employment within integrated systems increases, the separate on-call payment disappears from the formula and instead, is integrated in the overall compensation package."
On-call providers reported 971 hours worked per year for their annual stipend, 720 hours worked per month for their monthly stipend and 20 hours worked per week for their weekly stipend. Those who were paid on a daily rate were expected to be on call for a full 24 hours.
A federal grand jury has indicted two former hospital executives for their alleged roles in a bid-rigging conspiracy at New York Presbyterian Hospital, the Department of Justice announced.
The four-count indictment, handed up Tuesday in U.S. District Court in New York City, charges Emilio "Tony" Figueroa, a former director of facilities operations at NYPH, and Santo Saglimbeni, a former vice president of facilities operations at NYPH, with mail fraud and wire fraud.
Also indicted on the same charges were Michael Yaron and two companies owned by him, Cambridge Environmental & Construction Corp., which does business as National Environmental Associates, an asbestos abatement company, and Oxford Construction & Development Corp.; and Moshe Buchnik, president of two asbestos abatement companies. A third company, Artech Corp., owned by a relative of Saglimbeni, was also named in the indictment.
The indictment alleges that from 2000 through January 2008, Saglimbeni awarded asbestos abatement contracts, air monitoring contracts, and general construction contracts to Yaron, Buchnik and their companies at the same time that Saglimbeni sought and received cash kickbacks from the two men. The kickbacks were funneled to Saglimbeni through Artech, a company Saglimbeni created in a family member's name to conceal kickbacks, the indictment alleges.
In addition, between June 2001 and June 2006, Saglimbeni and Figueroa allegedly awarded contracts to install and repair the heating ventilation and air conditioning systems at NYPH to a co-conspirator's company in return for cash kickbacks and other gifts. Saglimbeni and Figueroa are also charged with mail fraud, because they allegedly had NYPH mail a payment on the fraudulently-awarded contract to a co-conspirator's company in May 2005, the indictment alleges.
The mail and wire fraud charges with each carry a maximum penalty of 20 years in prison and a $1 million fine.
The charges are part of an ongoing federal antitrust investigation of bid rigging, fraud, bribery, and tax-related offenses relating to construction, maintenance, and service contracts administered by the Engineering Department of Mount Sinai Medical Center and School of Medicine and the Facilities Operations Department and the Engineering Department of NYPH. To date, eight people and three companies have pleaded guilty to charges arising out of this ongoing investigation. Three other people were indicted on related charges on March 31.
AstraZeneca LP and AstraZeneca Pharmaceuticals LP will pay $520 million to resolve whistleblower allegations that AstraZeneca illegally marketed the anti-psychotic drug Seroquel for off-label uses, federal officials announced yesterday.
The Wilmington, DE-based company finalized the previously announced civil settlement to resolve allegations that—by marketing Seroquel for uses not approved by the Food and Drug Administration—the company caused false payment claims to Medicaid, Medicare, TRICARE, the Department of Veterans Affairs, the Federal Employee Health Benefits Program, and the Bureau of Prisons, the Departments of Justice and Health and Human Services said in a joint media release.
"Today's settlement sends a clear warning to any individual or company seeking to defraud our healthcare system and returns hundreds of millions of dollars of taxpayer money to the Medicare trust fund where they belong," HHS Secretary Kathleen Sebelius said.
AstraZeneca issued a brief statement on its Web site announcing the settlement but denying the allegations. Prosecutors said that AstraZeneca self-reported its conduct in 2006 and cooperated in the investigation.
The federal government will receive $302 million from the civil settlement, and state Medicaid programs will share up to $218 million, depending on the number of states in the settlement. Whistleblower James Wetta could receive more than $45 million from the federal share of the civil recovery.
Federal prosecutors allege that between January 2001 and December 2006 AstraZeneca illegally promoted Seroquel to psychiatrists and other physicians for uses that included aggression, Alzheimer's disease, anger management, anxiety, attention deficit hyperactivity disorder, bipolar maintenance, dementia, depression, mood disorder, post-traumatic stress disorder, and sleeplessness.
Prosecutors said AstraZeneca targeted its illegal marketing towards doctors who do not typically treat schizophrenia or bipolar disorder, such as geriatricians, primary care physicians, pediatric and adolescent physicians, and in long-term care facilities and prisons.
Prosecutors said AstraZeneca unduly influenced the speakers conducting company-sponsored continuing medical education programs. The drug maker also hired doctors for promotional programs on unapproved uses for Seroquel, to conduct studies on unapproved uses of Seroquel, and to serve as authors of articles that were ghostwritten by medical literature companies. AstraZeneca used the studies to promote unapproved uses of Seroquel.
Prosecutors also contend that AstraZeneca violated the federal Anti-Kickback Statute by paying doctors it recruited to serve as authors of articles written by AstraZeneca and its agents about the unapproved uses of Seroquel. AstraZeneca also illegally paid doctors to travel to resorts to "advise" AstraZeneca about marketing messages for unapproved uses of Seroquel, and paid doctors to give promotional lectures to other healthcare professionals about unapproved and unaccepted uses of Seroquel.
The settlement includes a five-year corporate integrity agreement.
A new report by a casualty insurance industry think tank says hospitals are cost-shifting billions of dollars in overcharges to automobile insurance companies to offset low reimbursements from Medicare/Medicaid.
A spokeswoman for the American Hospital Association did not deny the allegation. "This report highlights what hospitals have long known: Medicare and Medicaid pay less than the cost of caring for patients," said Caroline Steinberg, AHA’s vice president for trends analysis for policy. "When the government fails to pay its share of healthcare costs, it threatens the financial viability of hospitals, and places upward pressure on the rates paid by private insurers."
The Insurance Research Council report said that in 2007 auto insurance companies paid more than $1.2 billion in excess hospital charges for bodily injury liability claims in 38 tort and add-on states. The full impact of hospital cost shifting, including that in other states, is likely much greater, and will likely prompt auto insurers to more closely scrutinize and negotiate hospital bills, the report said.
"The conventional wisdom is that hospitals aggressively seek to shift costs from public insurance programs to private payers such as auto insurance companies," said Elizabeth Sprinkel, senior vice president of the IRC, in a media release. "With this study, we now have information on the magnitude of cost shifting and a better understanding of the need for supportive state laws and effective tools that will enable auto insurers to pay hospitals appropriately and help control auto injury claim costs."
Steinberg suggested that cost shifting will be an issue as long as hospitals lose money on Medicare/Medicaid, which pay for more than 50% of the care provided by hospitals. In 2008, she said, Medicare/Medicaid payments averaged 90 cents for every dollar spent by hospitals, even as hospitals provided more than $36 billion in uncompensated care. More than half (53%) of hospitals received Medicare payments less than cost, and 56% of hospitals received Medicaid payments less than cost, Steinberg said.
The IRC study, Hospital Cost Shifting and Auto Injury Insurance Claims, studied more than 42,000 auto injury claims. Twenty-two insurers representing 58% of the private auto insurance market participated. The study collected detailed data on injury, medical treatment, claimed losses and total payments, claim handling techniques, and attorney involvement.
IRC found that key predictors of average hospital charges are the percentage of a state's population without health insurance, and the percentage of the population covered by Medicaid.
Sprinkel said the IRC has yet to determine the impact of healthcare reform. "Healthcare legislation enacted by Congress last month underscores the complexity of this relationship," she said. "It will take months, if not years, to understand the full impact of the reforms on hospital cost shifting and the auto insurance system."
Toe Myint, MD, was sentenced Monday in Detroit to six years in prison for his part in a Medicare fraud scheme at sham infusion clinics. An accomplice who recruited patients into the scam will serve more than three years behind bars, federal authorities said.
Myint, of Bloomfield Hills, MI, was also ordered to pay more than $3.1 million in restitution, jointly with co-defendants, and to serve two years of supervised release following his prison term. Terrence Hicks, of Jackson, MI, the patient recruiter, was ordered to pay more than $4.9 million in restitution, jointly with co-defendants, and to serve three years of supervised release following his prison term.
Myint, 56, was convicted by a Detroit jury on Jan. 22, of one count of conspiracy to commit healthcare fraud, following a week-long trial. In the last three months, three Michigan doctors have been convicted of separate healthcare fraud offenses as part of the Medicare Fraud Strike Force operations in Detroit. Hicks, 43, pleaded guilty to one count of conspiracy to commit health care fraud on Dec. 18.
Between October 2006 and March 2007, Myint, Hicks and their co-conspirators submitted more than $4.2 million in false claims to Medicare for services supposedly provided by Myint at Sacred Hope Center Inc., a purported infusion clinic. Medicare paid more than $3.1 million of those claims. Hicks also worked at a second, related infusion clinic, called Xpress Center, Inc., which billed an additional $2.3 million in false and fraudulent claims to Medicare.
So far, 11 defendants have pleaded guilty or have been convicted at trial for their roles in the two fraudulent clinics. Daisy Martinez, an owner of Sacred Hope and Xpress Center, was sentenced in March to eight years in prison.
