Journal of Urgent Care Medicine

Disclosure and Billing Practices Are Central to Suit Against Adeptus

“Surprise” bills are a common complaint among patients who’ve visited freestanding emergency departments (FSEDs). While that hasn’t stopped their growth, billing practices have become the subject of pending legislation around the country—and, now, one basis of a suit against Adeptus Health, the nation’s largest operator of FSEDs. The Oklahoma Law Enforcement Pension (OLEP) has initiated a class action lawsuit against Adeptus, its private equity firm, and its officers related to its secondary stock offering, claiming …

Proper Billing Operations Are the Best Defense Against Fraud Charges

The case of a Canton, MI urgent care provider charged with 22 counts of medical fraud should serve as a cautionary tale and a reminder that unethical (or even just plain sloppy) billing practices can land operators, office staff, and physicians in hot water—or even jail. The physician in the Michigan case stands accused of billing Medicaid and Blue Cross Blue Shield for services he didn’t provide, resulting in nine counts of Medicaid fraud, 12 …

On the Heels of Medicare Fraud Sweep, Advice on Creating a Compliance Program

Recently we told you more than 300 people were charged with healthcare fraud involving some $900 million in false billings. Surely some were out to juke the system, but others were probably guilty of nothing more than poor compliance practices. Either way, the government is likely to continue cracking down on this multibillion dollar waste, making it a prudent time to shore up your own compliance program (as required under the Affordable Care Act [ACA, …

DOJ Sweep Underscores Need for Toeing the Line in Medicare Practices

Physicians and nurses were charged along with business owners after the Department of Justice moved in on scores of clinics that were allegedly involved in fraudulently collecting fees from Medicare and Medicaid. The DOJ says more than 300 people were charged in healthcare fraud schemes involving $900 million in false billings. Sixty suspects were allegedly linked to schemes involving Medicare Part D, which is the fastest-growing component of Medicare, overall. According to court documents, the …

What Urgent Care Operators Need to Know About New OSHA Requirement

Some urgent care and occupational medicine providers have questions regarding the new OSHA requirement for Safety Data Sheets (SDS), effective June 1, 2016. Essentially, to be compliant you must: Make sure all of your Material Data Safety Sheets (MSDS) are replaced with Safety Data Sheets (SDS) Assure that all hazards in your urgent care center are labeled with the new pictograms Re-up any training you’ve provided employees on OSHA compliance OSHA requires that employers keep …

Beware: Online Reviews That Expose Patient Information Go Too Far

Urgent care centers and other facilities often ask patients to rate their experiences. However, the Federal Trade Commission says online reviews that include too many details constitute a violation of patient privacy, even if the patients themselves provided the information. The problem is that some survey companies don’t make it clear that reviews will wind up on the internet. Most recently, the FTC reached a settlement with Practice Fusion, a cloud-based electronic health records vendor, …

Prosecutors Vigilant to Questionable Medicare Bonuses

A settlement with a billing company in Massachusetts is just the latest outcome of federal prosecutors going after healthcare companies for return of Medicare bonuses claimed in error. It’s a reminder that filing for claims improperly—even if inadvertently—can have serious consequences for operators. In this case, Medical Reimbursement Systems Inc. has agreed to pay $500,000 to settle allegations that it submitted false claims to the military’s Tricare program on behalf of a medical practice in …

‘Defensive Medicine’ May Actually Lower Malpractice Risk

Findings of a new study seem to support the notion that “defensive medicine”—eg, ordering tests even when not specifically indicated clinically—may offer some degree of protection to urgent care centers and other medical facilities. The study, authored by a team from Harvard Medical School led by Anupam B. Jena, MD, PhD, found an inverse association between spending and probability of a malpractice claim. In other words, employing greater resources reduced the risk of a malpractice …