Linda Rodrigue

Subscribe to Linda Rodrigue's Posts

Two recent studies published by the office of the National Coordinator for Health Information Technology (the “ONC”) suggest that the use of electronic health records among physicians and hospitals has greatly increased. The study is based on information collected in calendar year 2013.

According to ONC, approximately 78% of office-based physicians have adopted some form…

The Office of Inspector General (“OIG”) of the United States Department of Health and Human Services (“HHS”) has issued a report criticizing the Centers for Medicare and Medicaid (“CMS”) and its Recovery Audit Contractor (“RAC”) Program. In a report issued on September 4, 2013, the OIG determined that CMS need to take corrective action on…

Act 337 of the Regular Session of the 2011 Louisiana Legislature enacted an amendment to Louisiana R.S. 37:1285(A) to add new subsection (A)(32), which provides an additional ground for physicians to be disciplined by the Louisiana State Board of Medical Examiners (the “LSBME”). The new ground relates to a physician holding herself/himself out to the…

The Patient Protection and Affordable Care Act that was promulgated in March, 2010, includes provisions for creating Accountable Care Organizations (“ACO”). An ACO is an “organization” that is intended to manage the care of a minimum of 5,000 Medicare beneficiaries, with the purpose of improving outcomes to those beneficiaries. In the event an ACO is capable of achieving that goal, the resulting savings to the Medicare program will be shared by the federal government and the ACO.

How an ACO may be structured is left to the imagination and ability to appropriately structure an ACO arrangement. The federal government has not identified what an ACO structure must be. It may, for example, include relationships among hospitals, physicians/physician organizations, home health agencies, rehabilitation agencies, or any single or a combination of any of these types of providers. An ACO may even contain a payer component.Continue Reading Where Do You Stand on the Subject of Accountable Care Organizations?

Health care reform legislation increased the tools the government can use to recover money incorrectly paid to providers. The risk to providers of retaining overpayments has increased significantly.

Effective March 23, 2010, the law requires a person (including health care providers who are reimbursed under part A and Part B) who has received an overpayment from claims billed to Medicare or Medicaid to report and return the overpayment to the Secretary of HHS, the State, the intermediary, carrier, or contractor, as appropriate. In addition, the person must state the reason for the overpayment.Continue Reading Failure to Report and Return Identified Overpayment can be a False Claim

On July 13, 2010, the Centers for Medicare and Medicaid Services (“CMS”) published a proposed rule that would require physicians to disclose to their patient(s), at the time of ordering a CT, MRI or PET Scan service that may be performed in the physician’s office, the name, address, telephone number and distance from the physician’s office of ten (10) competing suppliers of the CT, MRI or PET Scan service where the patient may wish to have the test performed. This proposed rule implements a provision in the Patient Protection and Affordable Case Act (the “PPACA” or “Health Care Reform Legislation”) that mandates the disclosure at the time the test is ordered.
Continue Reading CMS Issues Proposed Rule on Disclosure Requirements for Certain In-Office Imaging Services

In May, 2009, the United States Court of Appeals for the Eleventh Circuit ruled that, among other things, a Florida dermatologist’s failure to produce photographs, which were part of her medical records, in response to a grand jury subpoena constituted obstruction of justice.  The dermatologist had been convicted of health care fraud, filing false claims and obstruction of justice in the trial court.
Continue Reading Changing Medical Records Responsive to a Jury Subpoena Ruled an Obstruction of Justice In Health Care Fraud Case

In April, 2009, the United States Court of Appeals for the Sixth Circuit decided in reviewing a Michigan case that the representative of a deceased woman could sue a hospital under EMTALA for allegedly releasing her husband after admission to the hospital, when he was then hallucinating, disoriented, and behaving in a threatening manner toward her when he was brought to the emergency department.  Five days after admission, it was decided that the husband should be transferred to a facility for the acutely mentally ill.  However, the transfer did not occur and he was, instead, released seven days after admission.  Ten days later, he murdered his wife.
Continue Reading Federal Court of Appeals Holds That Someone Other Than the Patient May Sue Under EMTALA

In May of this year, the United States Court of Appeals for the Fifth Circuit absolved Lakeview Regional Medical Center (“Lakeview”) of any liability, and reversed a damage award against it, in a lawsuit that had been brought against Lakeview and a physician group practice by Kadlec Medical Center, a hospital located in the state of Washington. Kadlec sued Lakeview and a physician practice for over $8 million in damages, on the grounds that Kadlec was forced to settle a malpractice lawsuit due to the negligence of an anesthesiologist who was impaired at the time of the malpractice. Kadlec’s claim was that Lakeview and the physician group practice knew of the physician’s impairment when he was on the medical staff of Lakeview, were asked about his performance before he was credentialed at Kadlec, and did not disclose the prior impairment and disciplinary action that had resulted.
Continue Reading Federal Court of Appeals Absolves Louisiana Hospital of Liability in Failure to Report Physician Impairment While on the Medical Staff