Biomedical subjects

F P Fedor

Publications and source records attributed to F P Fedor.

5 recordsLinked to original sources

PubMed2001

Percentage compensation arrangements: suspect, but not illegal.

Percentage compensation arrangements, in which a service is outsourced to a contractor that is paid in accordance with the level of its performance, are widely used in many business sectors. The HHS Office of Inspector General (OIG) has shown concern that these arrangements in the healthcare industry may offer incentives for the performance of unnecessary services or cause false claims to be made to Federal healthcare programs in violation of the antikickback statute and the False Claims Act. Percentage compensation arrangements can work and need not run afoul of the law as long as the healthcare organization carefully oversees the arrangement and sets specific safeguards in place. These safeguards include screening contractors, carefully evaluating their compliance programs, and obligating them contractually to perform within the limits of the law.

Contract Services↗

PubMed2001

Resolving conflicts between EMTALA and managed care requirements.

The Emergency Medical Treatment and Active Labor Act (EMTALA) requires a hospital to provide services to persons who come to the emergency department (ED) for emergency treatment without regard for their ability to pay. Yet some managed care plans require that the hospital obtain authorization before rendering emergency medical treatment, with the result that hospitals risk either nonpayment for services or violation of EMTALA. Hospitals can improve their payment rates for ED care by amending or challenging preauthorization requirements and insisting that plans apply a uniform standard of care to treatment of ED patients.

Conflict, Psychological↗

PubMed2000

Cost-effective compliance for the small provider.

Small provider organizations often have limited resources with which to implement a compliance program. The Office of Inspector General (OIG) has indicated that a small organization may take a less formal approach to compliance and develop a compliance program that fits its budget and resources. But small providers should take seriously the need for a compliance program despite the OIG's greater latitude toward small organizations. Whatever the size of their budget, small providers should emphasize due diligence and good-faith approaches to compliance to demonstrate to investigators and employees that they have made compliance a priority. These efforts can encourage the OIG to look more favorably upon the organization in the event of a compliance breach and also can improve the organization's financial performance by improving overall management of the organization.

Budgets↗

PubMed1998

Advisory opinions help clarify antifraud and abuse laws.

In 1997, the Office of the Inspector General published new procedures that allow requesters to obtain an advisory opinion as to whether a particular arrangement complies with the Federal anti-kickback statute. This process gives healthcare organizations a valuable new means by which to create individualized "safe harbors" for specific business arrangements. The advisory opinion process also may be integrated into a healthcare organization's corporate compliance program to help maintain the program's effectiveness.

Fraud↗

PubMed1998

New exclusions and penalties complicate compliance programs.

A new final rule and a proposed rule published September 2, 1998, by the HHS Office of Inspector General (OIG) outline regulations that implement enforcement provisions of the Health Insurance Portability and Accountability Act of 1996 and the Balanced Budget Act of 1997, respectively. The rules give the OIG discretionary authority to exclude organizations from participation in state or Federal healthcare programs or exact civil monetary penalties for certain types of infractions. Healthcare organizations, therefore, need to understand these rules and incorporate corresponding changes and processes into their compliance programs to avoid violations that could lead to penalties or exclusions.

Fraud↗