Wednesday, May 15, 2013

Texas Bill Would Let Doctors Get Data From Driver’s Licenses


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Health care providers in Texas could soon collect or verify patient information by swiping that patient’s driver’s license.
Allison V. Smith for The Texas Tribune
Proposed legislation is part of an effort to enhance electronic records. Above, a patient in Plano uses an iPad for a screening.
The Texas Tribune
Expanded coverage of Texas is produced by The Texas Tribune, a nonprofit news organization. To join the conversation about this article, go
The measure allowing such data collection is one of a handful that the Texas Medical Association is pushing this legislative session to help modernize medical practices. The association is also backing bills that would standardize preauthorization forms used by health plans for prescription drugs and health care services.
“A lot of these things are easy fixes,” said Dr. Michael Speer, president of the Texas Medical Association. “It’s just a matter of getting enough people to come together and agree that it’s the right fix.” (The Texas Medical Association is a corporate sponsor of The Texas Tribune.) The association, which represents more than 47,000 physicians and medical students, asserts that time and money are wasted on bureaucracy, and that each physician spends nearly $83,000 a year on administrative costs. It donated more than $1.3 million to state candidates in 2011 and 2012.
Medical practitioners must follow myriad procedures for billing private and public health plans. Many hire additional staff members to handle the paperwork, and simple errors can obstruct payment.
“It’s an extremely inefficient business model,” said Dr. Bernard Swift Jr., chief executive of Texas MedClinic, a network of urgent-care facilities.
Dr. Swift said Senate Bill 166, which is awaiting the governor’s signature, would eliminate repetitive paperwork by allowing licensed health care providers to collect accurate patient information from a driver’s license. Now, only hospitals in Texas are authorized to do so.
Senate Bills 644 and 1216, which have been approved by the Senate and referred to a House committee, would standardize the preauthorization forms required for prescription drugs and health services.
If health plans used the same or similar forms, it “could make a dramatic difference in the amount of manpower hours” spent on paperwork, said Representative John Zerwas, a Republican from Simonton. Dr. Zerwas, who is also an anesthesiologist, sponsored S.B. 644.
Although insurance industry representatives originally opposed the preauthorization form bills, they support the revised versions of the legislation that would set up expert advisory councils at the Texas Department of Insurance to ensure that the state’s standardized forms match federal standards and allow for electronic transmission of the records.
“Let the experts determine form and format,” said David Gonzales, executive director of the Texas Association of Health Plans. In health care, “standards at the national level are the preference. You don’t want 50 different state approaches.” (The Texas Association of Health Plans is a corporate sponsor of The Tribune.)
As physicians adapt their practices to the digital era, collecting accurate patient data — like that from a driver’s license — will help improve payment systems, ensure patient safety and prevent insurance fraud, said Nora Belcher, executive director of the Texas e-Health Alliance, an association of health technology stakeholders.
“What’s really best for the patient is complete data at the point of care,” Ms. Belcher said.

3 La. doctors indicted after nationwide Medicare probe

Two doctors in New Orleans and a third in Baton Rouge are among 11 new defendants indicted as a result of investigations by the Baton Rouge Medicare Fraud Strike Force, federal officials announced Tuesday in Washington, D.C.
Between $80 million and $100 million in fraudulent Medicare billings are alleged in two Strike Force indictments in Baton Rouge and New Orleans.
Attorney General Eric Holder and Department of Health and Human Services Secretary Kathleen Sebelius said the 11 defendants in the Louisiana cases are among 89 announced nationwide as people who sent Medicare a combined total of $223 million in fraudulent billings.
In Baton Rouge, Dr. Zahid Imran was identified last week as a new defendant in a Medicare fraud case that now targets 17 people for prosecution over losses prosecutors estimate at between $20 million and $49.9 million.
Imran, 55, said both before and after his indictment that he is innocent of charges that allege he conspired to commit health care fraud by falsely certifying patients for partial outpatient services at two Baton Rouge psychiatric clinics.
Those clinics were Shifa Community Health Center, in the 6700 block of Goya Avenue, and Serenity Center, in the 1000 block of Lobdell Boulevard. Imran, of Baton Rouge, also was an owner of Serenity Center.
Among those indicted in New Orleans federal court are Dr. Alvin Darby, 57, of Slidell, and Dr. Barbara Smith, 64, of Metairie. Both physicians are charged with conspiracy to commit health care fraud. They are alleged to have fraudulently certified ineligible Medicare patients for home health care services.
The indictment, made public Tuesday, alleges Darby and Smith accepted payments from Slidell businessman Mark Morad, 49, to certify patients for receipt of home health care services provided by three of Morad’s firms — Interlink Health Care Services, Memorial Home Health Inc. and Lakeland Health Care Services.
Between April 2005 and December 2012, the indictment says, the three firms billed Medicare a combined total of $51.7 million for home health care services. The firms were paid a combined total of $42.4 million by Medicare during that time, according to the indictment.
Darby could not be located for comment Thursday.
Smith, however, said she has never worked for Morad or for any of his three firms.
Smith emphatically declared her innocence, adding, “I definitely have not” fraudulently certified any patients for Medicare-covered services for any business person or company.
Demetrias Temple, 52, of New Orleans, and Nicole Oliver, 43, of Napoleonville, are identified in the New Orleans indictment as patient recruiters for Morad’s three firms.
Neither Temple nor Oliver could be reached for comment late Tuesday.
All five defendants are accused of conspiracy to commit health care fraud. Morad, Temple and Oliver also are accused of conspiracy to pay and receive health care kickbacks.
In Baton Rouge, new defendants in the psychiatric services investigation include Baton Rouge resident Rafat M. Jafri, 55. Jafri was an owner of a third clinic, Shifa Texas, in Houston, according to the amended indictment. He is accused of conspiracy to commit health care fraud, as well as conspiracy to pay and receive health care kickbacks.
A request for comment left on Jafri’s home answering machine late Tuesday was not returned.
Three Houston residents also are charged in the amended indictment in Baton Rouge. They are 47-year-old James R. Hunter, 45-year-old Anna Ngang and 33-year-old Osborne “Patrick” Wallace.
According to the indictment, Hunter was a Medicare-patient recruiter for Shifa Texas. Ngang is described in the indictment as a therapist and program director at Shifa Texas. Wallace, the indictment states, “was a recreational therapist employed at Shifa Texas.”
Hunter, Ngang and Wallace are accused of conspiracy to commit health care fraud. Hunter also is accused of conspiracy to pay and receive health care kickbacks.
Hunter, Ngang and Wallace could not be located for comment Tuesday.
A sixth new defendant in the Baton Rouge case is Erica Williams, 42, of Beaumont, Texas.
Williams appeared in federal court Thursday and pleaded guilty to one count of conspiracy in the Shifa and Serenity fraud cases. Chief U.S. District Judge Brian A. Jackson did not immediately schedule a sentencing hearing for Williams.

People who may have changed your life -

People who may have changed your life -

The IRS Raids 60 Million Personal Medical Records

5/15/2013 @ 11:28AM |5,379 views

The Internal Revenue Service is facing a class action lawsuit alleging that more than 60 million personal medical records were improperly accessed, and stolen, by agents from the embattled agency. It’s just one more reason, as I wrote yesterday, to re-think the agency’s role under Obamacare.
Inevitably, Obamacare confers the IRS with broad access to information about our health insurance, as well as direct electronic linkages into a new government super computer that will also store a lot of bottom line information about our individual healthcare choices.
It’s a recipe for mischief by an agency that’s proving that it can’t be fully trusted.
This isn’t a fictional, Orwellian vision. It’s a reality of how Obamacare was structured. And how much the law depends on enforcement meted out by the IRS.
The Obama Administration probably didn’t set out to design the system this way. But a myriad of concessions made to accommodate the law’s vast scope and intrusive provisions has placed many of its applications in the lap of the IRS.
In a story reported by Erin McCann of Healthcare IT News, (You can follow her on Twitter @EMcCannHITN), the IRS is alleged to have improperly accessed some 60 million medical records from 10 million Americans, including medical records of all California state judges.
According to a story by, whose correspondent Rebekah Kearn first reported on the legal skirmish, an unnamed healthcare provider in California is bringing the lawsuit against the IRS and 15 of its agents. The personal health information was allegedly seized by the IRS on March 11, 2011.
The medical records included information on psychological counseling, gynecological counseling, sexual and drug treatment, and other sensitive medical treatment data. A copy of the legal complaint can be purchasedHERE for $35.
“This is an action involving the corruption and abuse of power by several Internal Revenue Service agents,” the complaint reads.
“No search warrant authorized the seizure of these records; no subpoena authorized the seizure of these records; none of the 10,000,000 Americans were under any kind of known criminal or civil investigation and their medical records had no relevance whatsoever to the IRS search. IT personnel at the scene, a HIPPA facility warning on the building and the IT portion of the searched premises, and the company executives each warned the IRS agents of these privileged records,” it continued.
The claim asserts that the IRS agents’ seizure of medical records violated the 4th Amendment.
“These medical records contained intimate and private information of more than 10,000,000 Americans, information that by its nature includes information about treatment for any kind of medical concern, including psychological counseling, gynecological counseling, sexual or drug treatment, and a wide range of medical matters covering the most intimate and private of concerns,” the complaint states.
“Despite knowing that these medical records were not within the scope of the warrant, defendants threatened to ‘rip’ the servers containing the medical data out of the building if IT personnel would not voluntarily hand them over,” the complaint reads.
“Moreover, even though defendants knew that the records they were seizing were not included within the scope of the search warrant, the defendants nonetheless searched and seized the records without making any attempt to segregate the files from those that could possibly be related to the search warrant. In fact, no effort was made at all to even try maintaining the illusion of legitimacy and legality.”
According to the complaint, the IRS agents had a search warrant for financial data pertaining to a former employee of the John Doe company, however, “it did not authorize any seizure of any healthcare or medical record of any persons, least of all third parties completely unrelated to the matter.”
The IRS has not returned requests for comment.
Recent mischief over the political targeting of conservative groups should give us pause about turning over to the IRS a greater role in regulating healthcare.
Truth is, every indication suggests that the agency doesn’t even want the obligations it’s being given under Obamcare. It rightly recognizes that it has enough on its plate already.
There is no reason these bureaucratic burdens can’t be discharged elsewhere inside the government. The IRS was pulled into Obamacare not out of necessity, but expediency. It was judged that handing over certain obligations to the IRS would be the fastest way to get the law implemented.
The Obama Administration shouldn’t settle for this. Neither should we.
Americans should demand that the Obama team work a little harder to get its signature legislation off the ground without pulling the IRS so deeply into our healthcare choices — and bringing the agency so close to the private information about our medical care.
Follow Dr. Scott Gottlieb on Twitter @ScottGottliebMD

NeHC helps Healthwise spur engagement

eHealth Readiness Tool will help gauge consumer engagement processes

National eHealth Collaborative and Healthwise, a nonprofit organization that develops patient education and engagement technology, announced Tuesday that, as part of their collaborative efforts, Healthwise will make NeHC's Consumer eHealth Readiness Tool available to clients.
NeHC officials note that Healthwise is a longtime partner in helping to advocate the use of eHealth tools to help patients become full partners in their care. Healthwise Senior Vice President for Policy Leslie Kelly Hall is a member of the NeHCBoard of Directors and NeHC's Consumer Consortium on eHealth Steering Committee. She led an effort to bring stakeholders together to develop the NeHC Patient Engagement Framework, which was developed to guide healthcare organizations in developing and strengthening their patient engagement strategies.
The Patient Engagement Framework, which was developed with input from consumer and patient advocates, policymakers, technology organizations, healthcare providers and health plans, has been downloaded from NeHC's website nearly 8,000 times, officials say, and is being used as a conceptual model to inform patient engagement strategies.
The NeHC Consumer eHealth Readiness Tool is mapped to the Patient Engagement Framework and meaningful usecriteria, and serves as an online diagnostic tool to help organizations quantify, prioritize, and focus their improvement efforts and measure their progress toward IT-enabled consumer engagement.
In addition to working with NeHC and other interested stakeholders to spread the word about the Patient Engagement Framework and the CeRT, Healthwise is sponsoring several annual CeRT subscriptions that will be provided to select Healthwise clients.
Big Data and Healthcare Analytics Forum June 4-5 Washington
"Healthwise is a leader in the healthcare community, working to accelerate the use of health IT tools that help physicians and other providers better connect, communicate and empower their patients to take a more active role in their care," said NeHC CEO Kate Berry in a press statement.
"Engaging patients directly is critical to the transformation of healthcare - engaged patients take better care of themselves, which leads to better outcomes and lower costs," added Hall. "Making the CeRT available to Healthwise clients supports our mission of helping patients make better health decisions."

Providence Memorial Hospital Top Texas Patient Engagement Index Ranking

May 15, 2013, 2:31 p.m. EDT

CORRECTING and REPLACING Houston Northwest Medical Center, Park Plaza Hospital and Providence Memorial Hospital Top Texas Patient Engagement Index Ranking

Axial Exchange's Patient Engagement Index Ranks Hospitals Based on Personal Health Management, Patient Satisfaction and Social Media Engagement Data

RALEIGH, N.C., May 15, 2013 (BUSINESS WIRE) -- Third graph, third sentence of release should read: Lower ranking hospitals in the PEI included notable healthcare institutions like Parkland Hospital, which scored a 41 and University Hospital in San Antonio, which scored a 36.
The corrected release reads:
Axial Exchange's Patient Engagement Index Ranks Hospitals Based on Personal Health Management, Patient Satisfaction and Social Media Engagement Data
Axial Exchange, Inc., a pioneer in using mobile apps to deepen the patient's role in improving outcomes, today announced the results of its Texas Patient Engagement Index (PEI), a groundbreaking index that ranks U.S. hospitals based on an analysis of publically available data in three categories: personal health management, patient satisfaction and social media engagement. This is the second regional PEI the company has issued; the first ranked top hospitals in Florida. Both states were selected because their demographics make them bellwethers for the rest of the country.
Axial Exchange's methodology for ranking hospitals' patient engagement performance is based on analyzing metrics that research has indicated lower costs and improve clinical outcomes. For each PEI, Axial Exchange evaluates provider organizations' personal health management strategies, awarding maximum points to those organizations that not only offer electronic access to patient health records, but also provide resources for ongoing disease management support, including mobile, tablet and desktop tools. Axial Exchange also ranks hospitals according to an annual Centers for Medicare and Medicaid (CMS) patient satisfaction survey called the Hospital Consumer Assessment of Health Plans Survey (HCAHPS), a standardized instrument for measuring patients' perspectives on hospital care. Lastly, Axial Exchange analyzes the extent to which hospitals and health systems engage their patients via social networking channels.
The highest possible ranking a hospital can receive in Axial Exchange PEI is a score of 100. Top ranking hospitals in the Texas PEI included Houston Northwest Medical Center, which received an overall score of 84; Park Plaza Hospital, which received a score of 83; and Providence Memorial Hospital in El Paso, which received a 76. Lower ranking hospitals in the PEI included notable healthcare institutions like Parkland Hospital, which scored a 41 and University Hospital in San Antonio, which scored a 36.
"The term 'patient engagement' has been so widely used that its true meaning has been diffused; people talk broadly about improving patient engagement, but have not done the analysis and research to determine exactly what types of patient engagement programs improve outcomes," said Joanne Rohde, CEO of Axial Exchange. "However, we have done the research to determine which programs and tools actually drive more meaningful patient engagement that leads to improved patient satisfaction and clinical outcomes, fewer readmissions and lower healthcare costs. My hope is that these indices we have issued, and will continue to compile and share, will encourage provider organizations across the country to reevaluate their patient engagement strategies and place higher emphasis on the programs that drive real change."
Future indices for other U.S. regions will debut throughout the coming months. Detailed methodology of the Patient Engagement Index is published here. All Texas hospitals were notified of their ranking, and provided with links to the published data for consideration in their own initiatives toward Meaningful Use and heightened reimbursement levels.
About Axial Exchange, Inc.
Axial Exchange is revolutionizing the way that patients manage their health. With Axial, hospitals are able to keep their patients continuously engaged resulting in dramatically improved health outcomes and much more satisfied patients. Axial drives engagement by giving patients the information and interactive tools patients need in order to get well -- all delivered securely to the device of the patient's choice. Patients can share their health information with providers and care givers. Health systems benefit via lower readmissions and improved patient satisfaction scores.
In December 2011 Axial's flagship solution was named first-prize winner in the US Department of Health and Human Services' Partnership for Patients Initiative innovation competition for "Ensuring Safe Transitions from Hospital to Home." Axial Exchange is backed by a syndicate of top venture capital firms, led by Canaan Partners ( Visit
SOURCE: Axial Exchange, Inc.

$500 Million Whistleblower False Claim Settlement

Indian-based Ranbaxy Laboratories Ltd., has agreed to pay out $500 million to resolve allegations that the company was selling tampered and corrupted drugs to government medical programs. The drugs at issue were Sotret, gabapentin, and ciprofloxacin. The penalty is a combination of $350 million for settlement and $150 million following a guilty plea to charges from the U.S. Department of Justice (DOJ), $130 million of which is a fine. According to the DOJ, this is the largest generic-drug settlement in history.
Pharmaceutical companies have a history of putting their profits ahead of the well-being of the patients. Whether by failing to inform physicians of the possible risks associated with a drug or failing to ensure that a drug or product has been made in a consistently secure or safe environment, these companies do little to prevent potential injury to patients before the fact.
“The Department of Justice, with the assistance of another brave whistleblower, has once again shown the power of the False Claims Act and its potency in protecting American consumers and taxpayers from the byproducts of corporate greed and profiteering,” said James Kauffman, an attorney with the Levin, Papantonio law firm.
Just this year, the FDA has published recalls on the Fisher and Paykel Healthcare – Reusable Breathing Circuit, the GE Healthcare, LLC, Giraffe and Panda T-Piece Resuscitation Systems and the Giraffe and Panda Bag and Mask Resuscitation Systems, the Ad-Tech Medical Instrument Corporation, Macro Micro Subdural Electrodes and over twenty other devices since January of this year. The threats posed by the defects in these products are potentially serious and can sometimes result in death.
Ranbaxy has had a tumultuous past few years. In 2009, the FDA issued a statement that it would halt reviewing Ranbaxy’s drug applications as it obtained information that the company had falsified data and test results. The allegations were that the data obtained from the company supported the claim that the company made a practice of falsifying such information. Failing to properly test the shelf-life of the drugs was one such test that resulted in many of the company’s drugs being banned from import in the United States.
The practice of falsifying the statements was brought to investigators’ attention by a former Ranbaxy executive, Dinesh Thakur. Thakur alleged that the company falsely billed Medicare and Medicaid along with other government agencies. Of the settlement, Thakur will reportedly $48.6 million.
“Whistleblowers are an important part of uncovering corrupt practices in companies stealing from the government. The law provides for these whistleblowers a means to share in a potential recovery, but the method for exposing corruption can be complicated. It’s important that someone wanting to expose a scheme should contact an experienced attorney,” said Christopher Paulos, an attorney practicing in the areas of qui tam and whistleblower law.
In addition to the monetary settlement, the company has agreed to improve the processes it has in place to guarantee the integrity of its safety-test data and will sign a consent decree that will govern its business practices in the United States.
Joshua is a writer and researcher with Ring of Fire.

How waste is directly harmful to patients

Experts, most recently former CMS administrator Don Berwick, tell us that no less than 20% – 30% of medical care is waste. At the very least, waste is harmful to all those who pay for Medicare. But often it’s directly harmful to the patient as well.
I recently saw a friend at a party. Since we’d last seen each other my friend’s spouse had died. (I’m deliberately avoiding gendered pronouns and omitting other identifying details.) My friend contrasted the excellent hospice care the spouse received with problem-ridden hospital care. Here are two examples of waste that were thwarted only by my friend’s vigilance.
My friend’s spouse (“the patient”) was declining rapidly, and was admitted to the hospital. While my friend was attending to some bureaucratic aspects of the admission, the hospitalist ordered a CT and insertion of a PICC (peripherally inserted central catheter) line.
On returning to the patient’s bedside my friend pointed out that an identical CT scan had been done four days earlier.
The hospitalist responded, “I don’t have it.”
My friend replied, “Rather than putting such a sick person through another CT and spending another few thousand dollars, let’s get it.”
With regard to insertion of the catheter, my friend asked, “what aspect of the plan does it serve?”
The answer was it was an automatic part of a protocol, not tailored to the wishes of the patient and family. When their goals were clarified, the PICC line idea was dropped.
I know from my own practice experience that getting test results and records can be difficult. But repeating an identical test four days after it had been done elsewhere is a very expensive workaround that would have imposed avoidable distress on the patient. And although threading a catheter to place near the heart is a fairly routine hospital procedure, it carries risks (such as infection) and burdens (being hooked up to tubing). The hospital protocol should have required clarity about treatment goals before a non-emergency intervention was set into motion.
What struck me about these examples of overtreatment is how mundane they were. The hospitalist meant well. It was important for him to have the information the CT scan would provide, but repeating it wasn’t the right way to get it. And having routines can promote patient safety, but only when the routine is tailored to the true situation. In a non-emergency, getting clarity about the treatment goals of patient and family should be part of what we physicians routinely expect of ourselves.
My friend improved the spouse’s care and, at the same time, reduced costs. The public won’t be ready to consider reduced Medicare benefits or rationing until this kind of lose-lose waste is eliminated from the health system.
Jim Sabin is a psychiatrist and director, ethics program, Harvard Pilgrim Health Care.  He blogs at Health Care Organizational Ethics.