An anesthesiologist recently received a several-year prison sentence for prescribing controlled substances without a legitimate medical reason. One of this physician’s patients died from taking hydrocodone, which the physician had prescribed for no legitimate medical purpose. This is an extreme case involving criminal behavior. Still, any allegation of Medicare or Medicaid fraud or abuse surely ranks at the top of an anesthesiologist’s—any physician’s--list of nightmare scenarios. It behooves anesthesiologists, as well as nurse anesthetists and anesthesia practice managers, to know the “red flags” of fraud and abuse that could lead to civil, criminal or enforcement liability. Failure to understand current laws or how to take the appropriate steps could expose you to risk without your even realizing it. Did you know, for example, that the Affordable Care Act (ACA) requires physicians to establish a compliance program and to designate a compliance coordinator in their practices? Or that the ACA established an Open...

When most practice administrators started in anesthesia billing operations, collecting for services was markedly different than it is today, even if you are relatively new to the special. There are a variety of factors including government regulations, The Patient Protection and Affordable Care Act of 2009 (ACA), bundled payments, high deductible health plans, out-of-network payers and new plan designs, to name a few. The Patient Protection and Affordable Care Act “THE GREAT RACE TO THE BOTTOM” The Patient Protection and Affordable Care Act (ACA), or the ‘Great Race to the Bottom’ as some have coined it, brought massive change to the insurance market. Since the signing of this 2,000- page law in March of 2010, thousands of pages of regulations have been written and implemented. Moreover, additional regulations are on the way as the law gave the Secretary of the Department of Health and Human Services vast latitude to implement the...

We would like to say it isn’t so, but ransomware attacks haven’t tapered off; they’ve soared.  So far in 2016, ransomware attacks have risen 300 percent since 2015 (from 1,000 to 4,000 attacks daily), according to a government report.1  The healthcare sector—anesthesia providers included—is especially vulnerable. More than half of hospitals responding to an April survey by the Health Information and Management Systems Society (HIMSS) and Healthcare IT News reported that they had been attacked by ransomware in the previous year.  An additional 25 percent of hospitals said they were either unsure whether they had been attacked, or had no way of knowing.  When it comes to data security, healthcare still lags far behind other industries, including banking and high-reliability fields such as nuclear energy, power utilities and aviation. This susceptibility makes hospitals and practices prime targets for hackers.  Personal health information is 50 times more valuable on the black market...

Press releases following a recent publication in the British Medical Journal (BMJ) hysterically echoed the article’s headline: “Medical error—the third leading cause of death in the U.S.”1 The authors used a variety of published sources on the incidence, lethality and preventability of medical errors to produce an estimate of 251,000 deaths per year attributable to medical error, out of a total of about 2.6 million. As a cause of death this would rank behind only heart disease (611,000) and cancer (585,000). While the purpose of the authors was to advocate for improved coding of the cause of death in vital statistics, the purpose of the commentary was to alarm the public regarding the current state of healthcare. Should we panic? I think not. Here’s why: First, understand that I’m not a criminal or even an apologist. I hate medical errors and I have devoted my career to their eradication. We should...

The final rule implementing Section 1557 of the Affordable Care Act, Nondiscrimination in Health Programs and Activities, offers important civil rights protections for individuals. Anesthesia practices should understand the final rule, train staff in its provisions (or check with their hospitals on their plans for doing so) and make sure they are on target to meet the final rule’s procedural requirements. An anesthesiology group decides not to provide labor epidural anesthesia to women with limited English proficiency (LEP).1 A nurse ignores an African-American woman in the ER who needs medical attention and makes her wait for an hour, but provides prompt attention to a white male who enters the ER after her. A hospital refuses to treat men with breast cancer because it believes doing so would make female breast cancer patients uncomfortable. As you’ve probably guessed, these scenarios illustrate examples of discrimination under Section 1557 of the Affordable Care Act...