Discussion Accused of improperly billing Medicare for treatments
Introduction on Discussion Accused of improperly billing Medicare for treatments
A member of the hospital’s medical staff has been accused of improperly billing Medicare for treatments done in his office that were not medically necessary.
A subpoena for copies of patient records was received but the subpoena does not include a patient authorization for release of the records. In addition, the subpoena requests all “peer review committee” records pertaining to this physician. Consider the following questions:
- What must you check before releasing the patient records?
- What legal concept described in this chapter will determine admissibility of the hospital records into evidence?
- The defendant’s lawyer objects to the subpoena, arguing that the patient records are “hearsay.” To resolve this issue, identify at least one element that will likely be required in your testimony (or certification of the records).
- Your hospital attorney objects to the subpoena of the peer review committee materials, citing state law that protects peer review records from discovery. What legal concept describes this protection?
- In the course of acting on the subpoena, you discover that one of the patient records (which are electronic) has had major sections deleted. Your review of the audit trails determine that a hospital staff member was responsible for the deletions. Under what legal concept could the hospital be subject to liability for the deletions? What should have been done to protect the records?
You must proofread your paper. But do not strictly rely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort on your part and you can expect your grade to suffer accordingly.
Papers with numerous misspelled words and grammatical mistakes will be penalized. Read over your paper – in silence and then aloud – before handing it in and make corrections as necessary. Often it is advantageous to have a friend proofread your paper for obvious errors. Handwritten corrections are preferable to uncorrected mistakes.
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The paper must be neatly formatted, double-spaced with a one-inch margin on the top, bottom, and sides of each page. When submitting hard copy, be sure to use white paper and print out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument.
Disaster Mitigation and Preferences Among Members of StaffI