Can a health care provider conduct drug testing in-house?
This occurs if the health care provider decides to conduct drug testing in-house— drug testing results are treated as PHI and protected under HIPAA. For more information on these laws, purchase the Fundamentals Guidebook or sign up for The Fundamentals online course today! Applause for the Compliance Super Ninjas of 2021!
Why did UnitedHealthcare fail to fix its Medicare system?
The company blamed Medicare's nearly 15-year-old IT systems for the failure and urged the agency to invest in new equipment. A UnitedHealthcare representative says none of its 32,000 Medicare Advantage or Part D members affected by the SSA problem lost coverage. The company has the highest Medicare enrollment in the U.S.
Can a drug test result be released to an employer?
Health Insurance Portability and Accountability Act (HIPAA) HIPAA, which applies to Covered Entities and Business Associates, requires a release before Protected Health Information (PHI), such as drug testing results, can be provided to the employer.
Can an employer rescind a job offer after a drug test?
The EEOC alleges the employer made a job offer to an applicant contingent upon a successful drug test. When the applicant tested positive for a prohibited substance, the employer rescinded the offer.
What form should a hospital report a patient's principal diagnosis?
The hospital should report the patient's principal diagnosis in Form Locator (FL) 67 of the UB- 04. The principal diagnosis is the condition established after study to be chiefly responsible for this admission.
What is CCI in Medicare?
Refer to the Correct Coding Initiative (CCI) for correct coding guidelines and specific applicable code combinations prior to billing Medicare. Provisions of this LCD do not take precedence over CCI edits.
How many people are affected by Medicare?
Medicare officials say approximately 250,000 people are affected. Medicare and Social Security say they expect that proper deductions and payments to insurers will resume this month or next. Insurers are required to send bills directly to their members for the unpaid premiums, according to Medicare.
How many members of Humana lost coverage?
Humana spokesman Mark Mathis says about 33,000 members were affected — or fewer than 1% of its total Medicare membership. None of those members lost coverage. The company blamed Medicare's nearly 15-year-old IT systems for the failure and urged the agency to invest in new equipment.
Why didn't Social Security pay my insurance?
Because of what the Social Security Administration calls "a processing error" in January, it did not deduct premiums from some seniors' Social Security checks and it didn't pay the insurance plans, according to the agency's "frequently asked questions" page on its website. The problem applies to private drug policies and Medicare Advantage plans ...
Is Medicare reinstated in Ohio?
In Ohio, a Medicare Advantage plan reinstated a member due to unpaid premiums less than 48 hours after the state's health insurance information program for seniors got involved , says director Christina Reeg. Medicare beneficiaries have had the option of paying their premiums through a deduction from their Social Security checks for more ...
Can Medicare avoid disenrollment?
With both steps, "plans can avoid invoking their policy of disenrollment for failure to pay premiums while the member is adhering to the payment plan," Jennifer Shapiro, the acting director for the Medicare Plan Payment Group, warned the companies in a May 22 memo.
Does Aetna have Medicare?
The company has the highest Medicare enrollment in the U.S. Aetna has not received payments for Medicare Advantage and drug plans for the months of February through May for 43,000 affected members, says spokesman Ethan Slavin.
Can Medicare be deducted from Social Security?
Medicare beneficiaries have had the option of paying their premiums through a deduction from their Social Security checks for more than a decade, she says. However, they can also charge payments directly to a credit card or checking account instead of relying on Social Security.
What is the final rule for Medicare?
This final rule aims to improve the quality, accessibility and affordability of the Medicare and Medicaid programs and to improve the CMS customer experience by providing transparency into drug prices with the goal of reducing the price to beneficiaries of certain prescription drugs and biological products. Currently, consumers have incomplete information regarding the cost of pharmaceutical products. As a result, they lack important information needed to inform their decisions, which likely leads to inefficient utilization of prescription drugs or biological product. This rule requires disclosure of prices to the general public for prescription drug and biological products advertised on television. This may improve awareness and allow the general public to respond, potentially increasing the efficiency of prescription drug or biological product utilization. While we expect this rule to put downward pressure on the list prices of drugs, we cannot quantify the level of this impact because there is not data or examples that we can use.
Why is the scope of the Medicare and Medicaid program limited?
The scope is limited to Medicare and Medicaid because we can directly link the lack of information and transparency on drug pricing to harm to those programs and their beneficiaries.
What are the XVIII and XIX of the Social Security Act?
Both Titles XVIII and XIX of the Social Security Act reflect the importance of administering the Medicare and Medicaid programs in a manner that minimizes unreasonable expenditures. See, e.g., Sections 1842 (b) (8) and (9), 1860D-4 (c) (3), 1860D-4 (c) (5) (H), 1866 (j) (2) (A), 1893 (g), 1902 (a) (64), 1902 (a) (65), 1936 (b) (2). In order to enable consumers to make good health care choices, which will in turn improve the efficiency of the Medicare and Medicaid programs, it is critical that they understand the costs associated with various medications. This is especially important where consumers have cost sharing obligations that may be significant. As discussed above, DTC television advertisements that do not provide pricing information may contribute to rising drug prices. Consumers of pharmaceuticals are currently missing information that consumers of other products can more readily access, namely the list price of the product, which acts as a point of comparison when judging the reasonableness of prices offered for potential substitute products. In an age where price information is ubiquitous, the prices of pharmaceuticals remain shrouded and limited to those who subscribe to expensive drug price reporting services. Consumers may be able to obtain some pricing information by going online to the websites of larger chain pharmacies. However, there are several reasons consumers are not likely to do this. First, while consumers make many critical decisions that bring about the ultimate writing of the prescription—making the appointment, asking the doctor about particular drugs, etc.—the physician, rather than the patient, ultimately controls the writing of the prescription. Second, meaningful price shopping is further hindered because the average consumer receives no basic price information. Arming a beneficiary with basic price information will provide him or her with an anchor price or a reference comparison to be used when making decisions about therapeutic options. Triggering conversations about a particular drug or biological product and its substitutes may lead to conversations not only about price, but also efficacy and side effects, which in turn may cause both the consumer and the prescriber to consider the cost of various alternatives (after taking into account the safety, efficacy, and advisability of each treatment for the particular patient). Ultimately, providing consumers with basic price information may result in the selection of lesser cost alternatives, all else being equal relative to the patient's care.
What is DTC in Medicare?
This final rule revises the Federal Health Insurance Programs for the Aged and Disabled by amending regulations for the Medicare Parts A, B, C and D programs, as well as the Medicaid program, to require direct-to-consumer (DTC) television advertisements of prescription drugs and biological products for which payment is available through or under Medicare or Medicaid to include the Wholesale Acquisition Cost (WAC or list price) of that drug or biological product. This rule is intended to improve the efficient administration of the Medicare and Medicaid programs by ensuring that beneficiaries are provided with relevant information about the costs of prescription drugs and biological products so they can make informed decisions that minimize their out-of-pocket (OOP) costs and expenditures borne by Medicare and Medicaid, both of which are significant problems.
How many comments were received in the 2018 DTC rule?
We received 147 comments in response to the October 18, 2018 proposed rule ( 83 FR 52789 ). Stakeholders offered comments that addressed both high-level issues related to DTC advertising as well as our specific proposals and requests for comments. We extend our deep appreciation to the public for its interest in lower drug prices and increased price transparency, and the many comments that were made in response to our proposed policies. In some instances, the public comments offered were outside the scope of the proposed rule and will not be addressed in this final rule.
What is Medicare Part D?
Medicare Part D allows beneficiaries to choose a private health plan offering prescription drug benefits, and these include a standalone prescription drug plan (PDP) for those with original Medicare or a Medicare Advantage plan that includes prescription drug coverage (MA-PD).
What is the largest payer of prescription drugs?
As discussed in the proposed rule, CMS is the single largest payor of prescription drugs in the nation. In 2017, CMS and its beneficiaries spent $224.6 billion ($166.2 billion net of rebates) on drug benefits provided under Part B ($30.6 billion), [ 2] Part D ($129.7 billion gross spend, $100.7 billion net of rebates), [ 3] and Medicaid ($64.0 billion gross spend, $34.9 billion net of rebates including federal and state funds). [ 4] An additional sum was spent on drugs furnished by hospitals under Part A's inpatient prospective payment system, but the precise amount is difficult to isolate because hospitals receive a single payment for all non-physician services provided during an inpatient stay (including drugs). In 2016, CMS and its beneficiaries spent more than $238 billion on prescription drugs, approximately 53 percent of the $448.2 billion spent on retail and non-retail prescription drugs in the United States that year. Each year overall expenditures on drugs by both the Medicare and Medicaid programs and their beneficiaries have increased at rates greater than inflation both in the aggregate and on a per beneficiary basis. [ 5] These dramatically increasing costs are a threat to the sustainability of the programs and harm CMS beneficiaries every day.
Why did Obama change the Medicare program?
Obama vowed to change the program to allow Medicare negotiate lower prices.
Who was the point man for Medicare?
Kraus cited a number of news articles, including one in the Milwaukee Journal Sentinel that said Thompson was the Bush administration’s "point man" on getting Medicare Part D through Congress; and one in the Philadelphia Inquirer that said Thompson "lobbied tirelessly" for the plan.
Who is the senator who blaming Uncle Sam for the drug price?
Uncle Sam barred from bargaining Medicare drug prices, Senate candidate Tammy Baldwin says, blaming rival Tommy Thompson. When it comes to the massive Medicare Part D prescription drug program, you’d think Uncle Sam would have pretty good leverage in negotiating drug prices.
What is Medicare Part D?
Negotiating drug prices. Medicare Part D is a voluntary insurance program for prescription drugs for people on Medicare. Congress created it by passing legislation in 2003, although the program didn’t take effect until 2006. Here is some background from PolitiFact National:
What happens if a drug test fails?
If the failed test resulted from the legal use of a prescription drug and the drug will not prevent the employee from performing the essential functions of the job, the employer will likely need to accommodate the employee’s drug use.
What is the case of EEOC v Bell Leasing?
The lawsuit, EEOC v. Bell Leasing, Inc., Civil Action No. 2:16-cv-02848, was filed on August 25, in the U.S. District Court for the District of Arizona. The EEOC alleges the employer made a job offer to an applicant contingent upon a successful drug test.
What is the EEOC complaint?
The EEOC alleges that the positive test was the result of the applicant’s use of a prescription drug in accordance with her doctor’s orders, but the employer refused to consider her medical evidence. The EEOC’s complaint seeks monetary and punitive damages, injunctive relief, and Americans with Disabilities Act (ADA) training.
What tests are not considered medical examinations?
There are a number of procedures and tests employers may require that generally are not considered medical examinations, including: tests to determine the current illegal use of drugs; physical agility tests, which measure an employee’s ability to perform actual or simulated job tasks, and physical fitness tests, ...
Can a pre-offer drug test include a drug panel?
(See Page 6) There are a number of procedures and tests employers may require that generally are not considered medical examinations, including: tests to determine the current illegal use of drugs; A pre-offer drug test cannot include testing for legal drug panels.
What are the violations of Stark self referral laws?
Violations of the Stark self-referral laws and the Anti-Kickback Statute. These violations include improper payments for referrals and non-cash payments. Many types of acts may violate Stark or Anti-Kickback laws.
Why was the hospital lawsuit improper?
The claims were improper because: The patient’s treatments were not provided pursuant to an individualized treatment plan designed to help the patient address specific mental health needs and reach achievable goals;
What is Medicaid fraud?
Medicaid fraud which generally involves people with federal health insurance because of low income. The False Claims Act also applies to hospital fraud, pharmaceutical fraud, medical spa fraud, and other types of medical fraud.
How many people were charged with drug crimes in 2017?
The Department of Justice announced on July 13, 2017, that 24 defendants were charged, after the unsealing of three indictments, with schemes intended to divert pharmaceutical pills to the streets.
What happened to the two doctors in Arkansas?
On April 2, 2014, the US Attorney for the Eastern District of Arkansas, announced that two married doctors were indicted by a federal grand jury for conspiring to commit healthcare fraud and for six acts of healthcare fraud. The male doctor was also charged with four acts of making false healthcare statements.
How much was the False Claims Act settlement?
Department of Justice Settles False Claims Act Charges for More Than $15.6 Million Against 16 Hospitals. On May 7, 2015, the Justice Department announced that a settlement was reached in the Eastern District of Arkansas for charges that 16 hospitals submitted false claims for Medicare payments.
What are some examples of Stark violations?
Examples of Stark violations include interest-free loans, medical directorship pay that is more than the value of the medical advice provided, improper discounts, and other improper transactions. The Anti-Kickback Statute is also aimed at making sure referrals are based on the needs of the patient and not the financial interests ...
When did OSHA change its reporting rules?
Occupational Safety and Health Administration (OSHA) OSHA revised its recording and reporting occupational injuries and illnesses regulation that went into effect December 1, 2016. The regulation included anti-retaliation protections to encourage employees to report work-related injuries, among other changes.
What is HIPAA release?
Health Insurance Portability and Accountability Act (HIPAA) HIPAA, which applies to Covered Entities and Business Associates, requires a release before Protected Health Information (PHI), such as drug testing results, can be provided to the employer.
What is pre employment testing?
Pre- Employment testing that occurs after a conditional offer of employment is extended; Reasonable Suspicion testing that is based on the employer’s reasonable suspicion that the employee is under the influence of drugs, based on objective and observable factors, such as employee appearance, speech, and/or behavior in the workplace; ...
What is the title of the Civil Rights Act of 1964?
In addition, compliance with the following federal laws should also be top of mind: 1. Title VII of the Civil Rights Act of 1964 (Title VII) Title VII applies to employers with 15 or more employees and prohibits discrimination in employment on the basis of race, color, religion, national origin, and sex. Drug testing programs that are applied ...
Does the ADA cover illegal drug use?
The ADA provides protections for an applicant/ employee’s use of prescription drugs taken under the supervision of a licensed health professional. But it does not protect illegal drug use. For ADA compliance, the employer should not have a blanket drug testing policy that covers legally prescribed medications.
Does OSHA require drug testing?
OSHA made it clear that the final rule allows post-accident drug and alcohol testing, but explained that there should be a reasonable possibility that drug use by the employee is a contributing factor to the reported injury or illness in order for an employer to require drug testing.
Does HIPAA apply to employee files?
Generally, HIPAA does not apply to an employer and its employee files, even if employee files contain medical records. Even so, it is important to keep employee health-related information confidential and filed in a separate confidential file, separate from the employee’s personnel file.