1. OIG EXCLUDES HOSPITAL FROM FEDERAL HEALTH CARE PROGRAMS FOR "FLAGRANT VIOLATIONS" OF CORPORATE INTEGRITY AGREEMENT—The OIG announced March 10, that it is excluding South Beach Community Hospital, formerly South Shore Hospital and Medical Center, from participation in federal health care programs for "repeated and flagrant violations" of its obligations under a 2002 corporate integrity agreement ("CIA"). The CIA was entered into as part of a False Claims Act settlement to resolve allegations that the hospital overcharged Medicare by submitting false cost reports for unallowable costs. The exclusion, which follows a notification of impending exclusion by the OIG in December 2005, is the first to result from a violation of a CIA. The hospital has the right to appeal the decision, but this does not seem likely as the hospital filed for bankruptcy on February 27. On the same day, the hospital was shut down by Florida's Agency for Health Care Administration as a result of health and safety violations. Despite the hospital's declining status, the exclusionary action represents a significant enforcement step. In the March 10 announcement, the OIG stated that the exclusion sends the message that it will not hesitate to take action against those that fail to abide by CIA obligations. Reporter, Scott McBride, Houston, 713.758.3480 or smcbride@velaw.com.
2. HEALTH CARE COSTS PAID BY GOVERNMENT TO BE MADE PUBLIC IN BID FOR TRANSPARENCY—CMS Administrator Mark McClellan indicated that the amounts the Medicare program pays for certain medical procedures will be posted on the CMS website in the next few weeks. The Administration also will ask the Federal Employees Health Benefits Plan and the Department of Defense's TRICARE program to disclose pricing information. In the coming months, pricing and quality information focusing on specific hospitals and physicians in select high-cost metropolitan areas also will be made available to consumers. This information will be based on claims data held by government health care programs and data provided by willing private employers and health insurers. The specific metropolitan areas have not yet been determined. This latest move by the Administration signals a serious policy focus on encouraging price transparency and encouraging consumer education in the purchase of health care services. Reporter, Susan Feigin Harris, Houston, 713.758.3465 or sharris@velaw.com.
3. JCAHO CLASSIFIES ITS HOSPITAL PERFORMANCE INFORMATION AS "PUBLIC UTILITY"—Joint Commission on Accreditation of Healthcare Organizations ("JCAHO") President Dennis O'Leary recently announced that JCAHO has terminated its plans to sell hospital performance data to certain third parties, including the Blue Cross and Blue Shield Association. JCAHO's plans had garnered substantial criticism from hospitals regarding privacy concerns and other issues. Within the next two months JCAHO will hold a meeting of "stakeholders" to decide how to best implement its decision to instead treat its database of hospital performance information as a "public utility," and make the data available at no cost to any individual or organization wanting access. Reporter, Jason Pinkall, Houston, 713.758.4570 or jpinkall@velaw.com.
4. NEW DRAFT TEXAS HOSPITAL LICENSING REGULATIONS—The Texas Department of State Health Services ("TDSHS") recently published a draft of new proposed hospital licensing regulations. The draft regulations are more than 250 pages long, and contain significant revisions to the current regulations. For example, the draft regulations make changes to the Hospital Functions and Services Requirements set forth at Section 133.41 of the regulations, including changes to the requirements applicable to emergency services, emergency services for survivors of sexual assault, the governing body, linen and laundry services, medical records, nursing services, and quality assessment and performance improvement. The draft regulations also make substantial changes to the Spatial Requirements for New Construction set forth in Section 133.163 applicable to emergency suites, obstetrical suites, and outpatient suites, as well as important changes to the regulations governing the licensure of buildings with multiple occupancies. The proposed regulations have not yet been published in the Texas Register, although publication is anticipated in the next few weeks. The Vinson & Elkins Health Industry Group is putting together a consortium to analyze the draft regulations and provide comments to the TDSHS. If you are interested in participating in the consortium, please contact Susan Feigin Harris at 713.758.3465 or sharris@velaw.com, or Jason Pinkall at 713.758.4570 or jpinkall@velaw.com.
To view this week's Health Briefs (a listing of Federal and Texas regulations affecting health care), visit our website at http://www.velaw.com/pdf/resources/HB031706.pdf.
For more information about Vinson & Elkins' HIPAA Consortium, please contact Brenda Strama at 512.542.8544 or bstrama@velaw.com.
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Editor: J.D. Epstein jepstein@velaw.com
Issue Editor: David Berry dberry@velaw.com
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