WASHINGTON, DC (Medical Newswire) The Department of Justice has joined a whistleblower suit accusing a pair of billing companies and its former owners of upcoding emergency department claims, U.S. Attorney Patrick Fitzgerald reports.
The suit names Dr. Robert Tetik, his wife Bonnie Tetik, the Chicago-area billing company they founded, EMSCO Billing Services Inc., and Raleigh, NC-based National Emergency Services Inc. and NES Holdings Inc., which purchased EMSCO in 1994. EMSCO handled billings and collected payments for emergency room physician services provided in client hospitals.
The complaint alleges that in 1989, the Tetiks instructed EMSCO employees to bill the Illinois Medicaid program at one of the two highest reimbursement codes, regardless of the actual level of services delivered.
When Medicaid codes were revised in 1992, the Tetiks had EMSCO staffers routinely upcode patient files, the complaint adds. EMSCO's clients included more than a half-dozen Chicago-area hospitals; similar overbilling problems troubled one of EMSCO's client hospitals in Maine, the feds say.
"EMSCO Billing Service's billing policy for Medicaid claims was not a product of simple misunderstanding of applicable coding requirements," the complaint maintains, pointing out that EMSCO did not upcode claims submitted to managed care organizations or private insurers.
The case originally was filed in 1996 by Linda Trombetta, a former EMSCO employee. The government is seeking triple damages on what it contends amounts to millions of dollars worth of inflated ER claims.
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RESEARCH TRIANGLE PARK, NC (Medical Newswire) Coming to grips with the HIPAA privacy standards isn't just a matter of learning new rules - it's also a matter of changing an organization's culture. No one knows this better than health information management professionals, who are finding themselves at the intersection of HIPAA regulations and organizational culture.
With many medical records - especially paper records - it will be impossible to use technology to limit access to only certain parts of the file. That's when HIPAA awareness and cultural change are most necessary. For example, covered entities must teach their people who go into the medical record that they can't be poking around aimlessly. "It has to be a surgical strike," counsels Kristen Rosati, an attorney with Coppersmith Gordon Schermer Owens & Nelson in Phoenix. "HIM folks have got to dive in, get what they need and get out with minimum fuss."
As the day-to-day privacy challenges start to take their toll on HIM specialists and medical records departments, it is more vital than ever to master the myriad small changes that the Privacy Standards demand - without getting overwhelmed by the details. Learn how at Eli Research's upcoming audio seminar with HIPAA expert Kristen Rosati. The conference, "HIPAA Privacy For Medical Records Departments," will take place on Thursday, March 21, 2002 from 1 to 2:30 p.m. EST. Rosati is one of Eli's most popular speakers, lauded for her ability to make complex rules understandable and vague mandates practical.
The disproportionate burden on medical records departments of implementing HIPAA will only increase over the next year. "Now is the time to get the practical preparation you need," says Rosati.
Program highlights include an overview of when HIM professionals can - and cannot - grant medical record access to other providers and personnel, special challenges of physician access, understanding and applying the minimum necessary standard and the most common pitfalls in amending patient medical record information - and how your whole team can learn to avoid them. Rosati will also cover must-know tips about tracking disclosures to provide an accounting to patients and how to manage a limited budget when the compliance burden falls heavily on your group.
For more information about registration and pricing, call 1-800-874-9180 or visit:
WASHINGTON, DC (Medical Newswire) The nation's largest Medicare Part A claims processor says it saved $1.1 billion in 2001 through its program integrity efforts - primarily through intensive reviews of providers' financial and medical records and Medicare secondary payer initiatives.
United Government Services, which handles 20 percent of all Part A claims, adds that it works closely with the HHS Office of Inspector General, the Federal Bureau of Investigation and the Centers for Medicare & Medicaid Services "to ensure appropriate action is taken" when improper payments are uncovered.
UGS, which dedicates 550 of its 1,300 employees to cost saving efforts, says it recovered $20 for every dollar spent on those initiatives.
NEWPORT BEACH, CA (Medical Newswire) Barry L. Friedberg, MD, a globally recognized leader in the field of anesthesia and provider of innovative care for the discriminating cosmetic surgery anesthesia patient, challenges anesthesiologists to add the propofol ketamine technique to their anesthesia tool kit so that cosmetic surgery patients everywhere can benefit. This March marks 10 years since Friedberg pioneered this innovative technique for office-based cosmetic surgery that eliminates the most common side effects of surgery: post-operative nausea and vomiting.
Friedberg will be joining the Society for Office Based Anesthesia (SOBA), the American Society of Dental Anesthesiology and the Japanese Dental Society of Anesthesiology at the joint anesthesia meeting on March 15, 2002 in San Diego.
"Ten years ago I developed the PK technique, now used by many members of SOBA throughout the United States, Canada, Australia, Japan and England, so that cosmetic surgery patients could enjoy a safe and PONV free experience; and it works amazingly well," says Friedberg. For maximum results, Friedberg has adopted the use of Bispectral Index(tm) monitoring to the combination of PK anesthesia. The BIS monitor improves accuracy of dosing propofol, saving 20 percent of unnecessary medication, resulting in less depression, less risk, improved safety and ultimately speeding recovery from anesthesia, saving many dollars in wasted anesthetic.
A clinical instructor in anesthesia at the University of Southern California, Los Angeles, Friedberg adds, "As I celebrate 10 years of unparalleled success, I challenge other anesthesiologists to embrace this technique. We are a society of knowledgeable consumers who deserve to know their anesthesia options when electing a cosmetic surgery procedure, and this is an option that should be available. As a patient advocate, I encourage patients to know their anesthesia options. You, your surgeon and your anesthesiologist should partner together to ensure that you have the best possible experience and outcome." Friedberg recently launched an important Web site for patients.
Typical of Friedberg's patient feedback: "The experience was amazing and I cannot believe how fast and comfortably I recovered. You are a master at what you do," says Denise Morris.
Explaining the PK plus BIS technique, Friedberg explains, "The (BIS) index monitor (Aspect Medical Systems Inc.) plays a crucial role by measuring the safe range of propofol at which the ketamine can be given. Ketamine produces a brief, dissociative condition during which the surgeon can inject local anesthesia for the planned surgery without hurting the patient. Using this unique approach for office-based anesthesia eliminates the need for opioid medications like Morphine, Demerol or fentanyl. Without the opioids, the unpleasant problem of PONV after anesthesia is essentially eliminated."
For the past decade, Barry L. Friedberg, MD, a Stanford trained, board certified anesthesiologist in Corona del Mar, CA, has practiced exclusively in the subspecialty of office-based cosmetic surgery anesthesia. He is the founder of the Society for Office Anesthesiologists, which merged with the Society for Office Based Anesthesia, a non-profit, international society dedicated to improving patient safety through education. SOBA includes anesthesiologists, certified registered nurse anesthetists and dentist anesthesiologists. Friedberg is the developer of PK technique. Many members of SOBA throughout the United States, Canada, Australia, Japan and England are enthusiastically using his PK technique in their practices. Friedberg has published five articles in peer reviewed journals on his technique. His original 1993 article has been cited in twelve subsequent peer reviewed journal articles and two textbooks in anesthesia. Friedberg is a frequent contributor to electronic discussion groups that include the SOBA, and the Society for Ambulatory Anesthesia Web sites.
He has also lectured in the United States, Canada, the Dominican Republic and Israel.
MAYWOOD, NJ (Medical Newswire) Kids in homes with parents who smoke may be at risk from second-hand cigarette smoke which has been associated with respiratory diseases and lung cancer.
Now, labs can detect at risk children early, improving their chances of avoiding these diseases. A new urine test is now available to measure exposure to environmental tobacco smoke. The test, manufactured by Nymox Pharmaceutical Corp., is the NicAlert. The company describes the screening device as a one-step test that's cost-effective and easy to use.
NEWTON, MA (Medical Newswire) The 18th Annual Toward an Electronic Patient Record 2002 Emerging Health Information Solutions Conference and Exhibition is being held May 11-16, 2002 at the Washington State Convention Center in Seattle. New technologies and their promised solutions will be tested, compared and measured by health professionals from around the world during six days of accredited sessions, demonstrations and exhibits.
Designed as four conferences in one venue, attendees are invited to choose freely among parallel programs that all address practical applications and tools for implementing information solutions. TEPR 2002 has more than 450 accredited educational sessions in four key areas.
"TEPR: Creating the Pathway to Electronic Health Care" addresses all clinical information, administrative and practice management issues with in-depth coverage including selecting and implementing electronic medical records, practice management, component technologies and much more.
"Mobile Health Care: Wireless Applications & Technologies" is simply the best mobile health conference available to the health care professional. This is a follow-up event to the sold out fall 2001 Wireless Conference in Las Vegas and covers best practice solutions for 14 applications, including data capture, connectivity, network solutions, e-prescribing, emergency care, integration and alert messaging.
"Health Care Security: Privacy, HIPAA & Beyond" helps attendees to transform compliance regulations into a strategy for successful integration with short and long term gains. This program is for the security expert and the health care practitioner who needs to develop a security infrastructure with tracks that address biometrics, authentication, user identification, public key infrastructure, Internet security, disaster recovery and data security.
"Results: Proven Value Propositions" is an entirely new and unique agenda for the chief executive officer, chief financial officer and chief information officer designed to help prioritize steps based on measurable risks. Evaluate first-hand health care information technology benefits in four major areas: measurable return on investment, reduced medical errors, improved efficiency and increased patient satisfaction.
Special events and demonstrations at TEPR 2002 include a mock trial, which will address the legal issues of implementing electronic signatures through a simulated malpractice suit regarding viability. Also held will be a clinical documentation challenge, the most exciting event of past TEPRs, providing a simulated real-life setting so that you can compare the leading approaches for converting physician thought into useful patient record entries. The American Academy of Family Physicians Spring Technology Continuing Medical Education program will be held during TEPR 2002 and is designed to help prepare physicians and their office managers for implementing technology into their practices. A program entitled Solution Seekers will allow attendees with specific questions to enter a criterion that directs them to the vendor with the answers. An awards presentation and ceremony will name "Best of Show" in 13 HIT categories as attendees compare products. In the biometric authentication challenge, companies will show product capabilities in an interactive demonstration. A gala event will be held on Tuesday, May 14.
TEPR 2002 brings together health care providers, information specialists, vendors and thought leaders responsible for implementing and maintaining a successful information infrastructure. Medical Records Institute sponsors the conference with support from Cap Gemini Ernst & Young, ECG Management Consultants, Eclipsys, GE Medical Systems, IDX, Mobilocity and Next Gen.
Discount registration for TEPR 2002 is available until March 16, 2002 by calling 617-964-3923 #223 or by registering online at www.tepr.com.
For exhibiting and sponsorship inquires call Ellen Boland at 617-964-3923 #226 or Kara Sanborn at 617-964-3923 #231.
About Medical Records Institute
MRI (www.medrecinst.com) is committed to promoting the development and acceptance of electronic health record systems. Since 1983, MRI has pursued this mission on a national and international basis by sponsoring educational programs, including TEPR (www.tepr.com), one of the largest health information technology conferences in the world, designed to share the knowledge, experience and solutions of health care informatics leaders and vendors. MRI supports, coordinates and leads the process of creating health care information standards by conducting surveys and studies related to selected EHR and standards issues, assisting EHR developers in finding alliances and partnerships and acting as a voice of conscience on aspects of confidentiality, security and social impact.
For free subscription information, visit www.medicalnewswire.com, e-mail subscribe@medicalnewswire.com or call (800) 874-9180.
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