HHS' inspector general's office has fined a California company more than $1 million-a record-for deceptive use of the word "Medicare" in its advertising and marketing materials.
The inspector general alleges U.S. Seminar in La Mesa had sent more than 362,000 letters to healthcare providers that made it seem the company's seminars on Medicare reimbursements and coding were approved, endorsed and authorized by Medicare. They were not.
Earlier this month, the agency, saying this case was a particularly egregious example of such violations, sent a demand letter to U.S. Seminar and three of its executives asking for $1,086,258 in civil penalties. The amount is the largest ever requested by the inspector general under the statute, says Katherine Harris, a spokeswoman for the office.
Calls to U.S. Seminar's lawyer in San Diego were not returned. The company has 60 days to appeal.
In the letter, the inspector general's office said the solicitations U.S. Seminar sent out were "highly misleading ... and (were) clearly designed to induce providers to pay to attend U.S. Seminar's programs based on a false impression that such programs were required by or were affiliated with Medicare or HHS."
According to the letter, the company had been warned before. In July 1997, an inspector general's office agent sent letters to and met with executives of the company to warn them that claims that its seminars were mandatory were unlawful.
Rather than cooperate with the warning, the company's officers formed another business, Doctor's Assistance Corp. to run seminars about privacy regulations connected to the Health Insurance Portability and Accountability Act of 1996, the inspector general charged. Employees told providers that to be in complete compliance with HIPAA, they had to attend the company's seminars, the inspector general's demand letter alleged.
With medical errors and quality of care issues in the news, it makes sense for caregivers-in-training not to start out practicing on their healthy fellow students or real patients. Technology has come to the rescue.
HealthPartners, a not-for-profit HMO based in Bloomington, Minn., and Metropolitan State University in St. Paul, Minn., have just opened the new HealthPartners Simulation Center for Patient Safety. It uses a human-patient simulator, state-of-the-art audiovisual equipment and several high-powered computers to teach students how to work with patients without inflicting bodily harm.
There are a dozen large centers like it around the country, most at elite medical schools such as Harvard and Stanford universities, but the HealthPartners facility is one of the first partnerships between a university and a provider, says Carl Patow, vice president at the HealthPartners Institute for Medical Education, which oversees residency and continuing medical education programs at 331-bed Regions Hospital in St. Paul.
The heart of the facility is the patient simulator, a $200,000 mannequin loaded with high-tech equipment and sensors that allow it to respond to treatment in much the way a human would. The patient dummy comes complete with blinking eyes and the ability to sense a cold stethoscope on its chest. The 6-foot-tall dummy has interchangeable body parts, wigs and voice programming that can make it male or female.
The video equipment allows students to work on their skills, observe their own mistakes and make corrections.
Allowing physicians, nurses and staff-in-training to work together as a team on dummy patients is still a novel idea, Patow says. "The purpose of this center is to give our healthcare students and professionals more practice and thus more confidence, before they start working on real people."
Soothing HIPAA anxiety
Worries about HIPAA keeping you up at night? Combat that sense of uncertainty, or those mixed messages about how to send payable healthcare claims, by going to a new, free Web site aimed at standardizing insurance-related communications between health plans and providers nationwide.
The site, wedi.org/snip/caqhimptools, is a collaboration of the Council for Affordable Quality Healthcare and the Workgroup for Electronic Data Interchange, two industry coalitions seeking to establish one focal point for complying with administrative-simplification regulations effective in October as part of the Health Insurance Portability and Accountability Act of 1996. A different set of HIPAA regulations protecting the privacy of patient medical information becomes effective this week.
The Oct. 16 deadline can make or break provider cash flow: The CMS will not accept noncompliant claims for Medicare reimbursement after that date, and commercial payers also are required to follow the standards. But a lot of close coordination between individual health plans and providers is required to synchronize their operations. "HIPAA specifies what payers must do to comply with HIPAA regulations, but it does not regulate how payers communicate this information to the provider community," says James Schuping, WEDI executive vice president.
"She did not lose her life, and with the plastic surgery she'll have breast reconstruction better than she had before. It won't be National Geographic, hanging to her knees. It'll be nice, firm breasts."
-Harry Metropol, a Columbia, S.C., physician, in testimony at a hearing of a South Carolina House Judiciary Committee's subcommittee on a proposed cap on noneconomic damages in medical malpractice lawsuits. He was responding to cap opponents who cited the case of Linda McDougal, a Wisconsin woman who lost both her breasts last year after being misdiagnosed with breast cancer and who now is a vocal national critic of limits on jury verdicts in such cases.