Disclosure Rules

Senators want info on who paid doctors

Anne Zieger — Fri, 17 Oct 2008 09:17:10 -0400

While they still haven't passed a law forcing drug companies and medical device firms to disclose payments to doctors--as some influential legislators still hope to do--that doesn't mean lawmakers are letting the subject rest on Capitol Hill. In fact, they're keeping the heat on high.

This week, Sens. Chuck Grassley (R-IA) and Herb Kohl (D-WI) sent requests for information on whether Columbia University and the Cardiovascular Research Foundation have received money from the medical-device industry. The letters follow a similar investigation that kicked off a few months ago, in which Sen. Kohl sent a letter asking the American College of Cardiology to explain some aspects of its relationship with CRF.

The senators want to know whether research physicians affiliated with these institutions received medical-device industry payoffs. Grassley and Kohl also would like to know more about the Cardiovascular Research Foundation's financial support for an annual conference that just happens to promote cardiac devices and techniques. (Did we mention that CRF just happens to get funding from medical device manufacturers like Medtronic and Boston Scientific Corp.?) They'd also like more data on financial relationships between professors of medicine and cardiac-device companies featured at the conference.

Several individual states have already passed laws requiring similar disclosures, including Vermont, Maine, Minnesota and West Virginia. If the Physician Payments Sunshine Act passes, meanwhile, pharmaceutical companies or medical device makers would face similar requirements everywhere in the U.S.

To learn more about the law:
- Read this Modern Healthcare piece (reg. req.)

Health plans drop out of CT Medicaid over disclosure rules

Tue, 13 May 2008 06:59:57 -0400

Connecticut's Medicaid program is struggling to regain its equilibrium after a standoff over new provider contracting disclosure rules prompted a handful of health plans to jump ship. In 2007, Gov. Jodi Rell (R) demanded that HMOs participating in Husky, the state's Medicaid program, share information on the details of their contracts with providers. Her position was that since they contracted with the state, they were, in essence, acting as public agencies for the purposes of participating in Husky.

The plans disagreed, however, arguing that they couldn't disclose proprietary contracting information. Two HMOs pulled out of Husky in April, leaving 120,000 Medicaid beneficiaries to transfer to other forms of coverage. A third will leave on July 1, bringing the total to 226,000 beneficiaries. Meanwhile, two participants, Anthem Health Plans and Health Net of Connecticut, are challenging the disclosure requirement in the Connecticut Supreme Court.

To learn more about the dispute:
- read this Kaiser Daily Health Policy Report item

Related Article:
CT court makes Medicaid plans disclose MD pay

Report: Antifraud compliance getting tougher for hospitals

Wed, 30 Apr 2008 06:59:57 -0400

A new report from the Deloitte Forensic Center argues that it's getting increasingly difficult for hospitals to comply with state and federal anti-fraud rules given the surge in new anti-fraud legislation. Laws and regulations designed to limit Medicare and Medicaid abuse have proliferated, while disclosure rules keep expanding, the consulting firm notes. Not only that, more regulation still may be in store. Regulators are paying increasingly close attention to relationships doctors have with hospitals and health systems, imaging centers, DME suppliers and other health professionals. For example, regulators recently began an information collection program that requires about 500 hospitals to file detailed reports on their contractual relationships with doctors.

To learn more about this issue:
- read this HFMA News item

Related Articles:
HHS seeks comments on model EHR anti-fraud standards
IT key to fighting Medicare, Medicaid fraud

HHS wants more detail in fraud self-disclosures

Wed, 16 Apr 2008 06:59:58 -0400

Since 1998, providers who voluntarily reported fraud to the HHS inspector general's office have been given leniency in their treatment. However, HHS now has changed the rules governing this policy. Under the new rules, providers will now have to provide a better explanation of what's being disclosed if they want gentler treatment. Providers will now have to offer a complete description of the questionable conduct, name which laws may have been violated, provide the results of an internal investigation, and offer an estimate of damages and the method used to determine them. (If the last two aren't available, providers are allowed to provide them later, as long as they wait no longer than three months.) If providers meet all of these requirements, and cooperate with the HHS IG, they can potentially walk away without having to sign a corporate integrity agreement, HHS officials said.

To learn more about these changes in fraud self-disclosure rules:
- read this Modern Healthcare article (reg. req.)