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Legislation in Tallahassee would force doctors and some medical care centers to post signs of about 3-feet-by-5-feet in their waiting rooms showing the prices to be charged a person paying out of pocket. Charges for the insured vary by policy and wouldn’t be posted.

“The cost of health care is a big mystery. Nobody knows how much health care costs. We need some clarity,” said Rep. Richard Corcoran, R-Trinity, the sponsor of one of the bills. “When consumers are price-conscious, they shop around, and there’s competition. That lowers costs and gives better quality.”

The same legislation would force urgent care centers owned by hospitals to disclose if they charge emergency room prices — as many do — so patients would not be surprised by the bills.

In addition, lawmakers would give a price break to patients who can’t give permission for treatment by a health provider that’s not part of their insurance network, such as when an ambulance rushes them to the nearest hospital.

The bills by Corcoran (HB 1329) and the Senate Health Regulation Committee chaired by Sen. Rene Garcia, R-Hialeah (SB 7186) are moving in the Legislature. Both come up for hearings on Wednesday.

The bills have drawn opposition from the powerful lobbyists of doctors, hospitals and other health businesses who argue the rules are punitive and take money from them.

Here’s what the bills would do:

Medical prices: Urgent care centers, surgery centers and imaging centers would have to post the signs showing prices for their 50 most common procedures.

Doctors’ offices would have to post prices on those signs under one bill; both bills require doctors to give each patient a price sheet at every visit. A Corcoran bill that become law last year made price disclosures voluntary for doctors, but few have done so, he said.

Medical groups said they not object to disclosing prices but don’t want to be forced to put up signs that would cost money and clutter waiting rooms.

“It doesn’t really help patients,” said Alison B. Dudley, a lobbyist for the imaging specialists in the Florida Radiological Society. “If I were shopping, I would prefer to do it by phone from my home rather than drive around to a bunch of places and look at the walls.”

Corcoran said he is a fan of price signs, having once been a consultant for Solantic, a chain of 30 Florida urgent care centers that features prominent price signs.

Hospital-owned urgent care: Each would have to post a sign telling patients if prices are the same as those charged in their hospital emergency room. Legislators said they have heard many complaints from patients who expected to be billed a lower fee typical of urgent care centers, but instead were billed at higher ER prices.

That’s what happened to Pembroke Pines insurance worker Lori Wills, who did not complain to the legislators. She had a five-minute doctor visit for a sore throat at a hospital-owned urgent clinic last year. The clinic could not tell her the price, but when the bill arrived later, the clinic charged $925, the doctor $233.

“If they had told me, I would have walked out,” said Wills, who is still fighting the charge. Shortly after the visit, she was treated for the same throat ailment at another urgent care center for $100.

Officials at some hospital-owned urgent clinics say they charge ER prices because the clinics do more than typical urgent care centers and serve as extensions of their emergency rooms. They say they are making clinic prices clearer to patients.

No out-of-network fees if you can’t choose: Patients almost always pay extra if they are treated by doctors and medical centers that are not included in their insurer’s network.

But what happens if you’re unconscious when an an ambulance takes you to an emergency room?

Both bills would waive extra fees for patients who had no control over whether they were treated by someone out of network. The patient would pay only the co-payment and deductible the insurer charges for in-network care.

The physician group Florida Medical Association opposes this, saying it would take money out of providers’s pockets. The legislation does not force insurers to pay non-network doctors or hospitals the extra fees that the patient would be excused from paying, the association said. Doctors may respond by no longer seeing out-of-network patients.

“The insurance company is the only winner in this scenario,” said FMA spokeswoman Erin VanSickle.

Gov. Rick Scott, who once owned Solantic, has taken no position on the two bills so far. Any bill approved by the Legislature would go to him for his signature.

But, Scott “believes that if consumers knew how much health services cost, they could make better informed decisions about their care — and it would create a more competitive environment among providers — which should ultimately reduce costs,” his office said in a brief statement.

via Sun-Sentinel

Born a female but identifying as a man, the Fort Lauderdale community activist dreams of having surgery to complete a transition fulfilled in every other way but one: He still has a woman’s genitalia. Changing that would mean going to the doctor and risking the very experiences he has long dreaded: ugly incidents that experts and studies say are all too common for the transgender community.

In an effort to improve the quality of and access to health care for what it calls “a small but substantial population,” the American College of Obstetricians and Gynecologists is urging OB/GYNs to create a more open, welcoming environment for transgender patients.

The hope is to make a dent in the abusive treatment that traditionally has scared this unique community away from doctors. The snickers and stares from the nurses‘ station. The irrelevant questions about birth control and family planning. Judgmental looks, statements and — for 2 percent of the population, according to a recent study — outright violence and physical harassment from doctors and staff. Some have even been refused treatment.

“The ignorance runs its course,” said Makalani-MaHee, who hasn’t had a pap smear in more than a decade after several uncomfortable doctor’s visits. “A lot of us have avoided these types of experiences.”

A recent survey found that almost 30 percent of the transgender community postpones care due to discrimination concerns. Transgender people represent 1 to 3 percent of the U.S. population (or 3 million to 9 million Americans) and 1.5 percent of Florida’s population (or 200,000 Floridians), according to what many consider highly conservative estimates from the Florida Organization Regarding Gender Equality.

For its part, the medical community is becoming increasingly concerned about the obvious health implications.

In the December issue of Obstetrics & Gynecology, ACOG issued a committee opinion recommending that doctors add a transgender option to their patient forms; post a non-discrimination policy in their offices; train staff to treat transgender patients with respect and sensitivity and offer them the same routine care and screenings they give others.

Defined as someone who strongly identifies with the other sex, a transgender often lives full time in the cross-gender role, but he or she does not always seek surgery to complete the transition — either because of financial limitations, fear of discrimination or similar factors.

The fears are well-founded. A 2011 study by the National Center for Transgender Equality and the National Gay and Lesbian Task Force found that 19 percent of 6,450 respondents had been refused care due to their transgender status; 28 percent were subjected to harassment by medical personnel; and 2 percent were victims of violence in doctor’s offices.

“The consequences of inadequate treatment are staggering,” the ACOG opinion states, noting high suicide and self-mutilation rates among transgender people, more than half of whom also seek illegally obtained hormone or silicone injections from unlicensed providers.

And then, of course, there are the illnesses and diseases that, without routine preventive care, go undetected — until it’s too late.

“It’s a flipping tragedy when you have someone with Stage 4 cervical cancer, and you find out that the reason they haven’t had a pap smear in 20 years is because the first doctor they saw was mean,” said Dr. Lanalee Araba Sam, a Fort Lauderdale OB/GYN. “With that first exam, you’ve got to make it good, or they’ll disappear into the woodwork forever.”

Gynecologists, especially, can prove critical to a transgender patient’s care — for transitioning males who still have female biological parts; for transitioning females taking hormone injections; and for those going through gender-affirmation surgery.

For the past several years, Rajindra Narinesingh, 44, has been getting her estrogen hormone injections from an open-minded and friendly general practitioner. But she’s leery of trying out any more doctors after an earlier experience with a snickering, giggling nursing staff.

Born a man but living as a woman, Narinesingh wants surgery to complete the transition, but she’s put off a final decision, partly because of financial concerns and partly for fear of discriminatory treatment. The ACOG recommendations, though, give her heart that she may one day feel comfortable enough to fulfill a longtime goal.

“Do you realize how comforting it would be to know the OB/GYN community would be open and receptive to it?” the Hollywood resident said. “It’s definitely a plus when you’re factoring in life after surgery. That’s a very big step for a trans-person.”

Gynecologists like Sam already have taken the step, making their waiting rooms more unisex, their questionnaires more trans-friendly and their staffs more sensitive to a diverse patient population. Such changes, said Makalani-MaHee, 39, are “going a country mile in welcoming and affirming” patients like him.

His quest for gender affirmation surgery, and Sam’s welcoming practice, have inspired Makalani-MaHee to make an appointment for that long-dreaded gynecologic exam.

In the nine years since she’s been a practicing OB/GYN in South Florida, Sam said she’s noticed a gradual difference in the gynecological field’s openness to LGBT patients, a receptiveness reflected by ACOG’s recommendation. And she attributes the evolution to the fact that young doctors specializing in gynecology today are overwhelmingly female and grew up in a more tolerant era.

“I feel that the Hippocratic Oath — do no harm — includes ‘have some charm.’ The thing that needs to be recognized is customer service and respect for your patient, and that excludes your biases.”

Still, the old-fashioned biases remain pervasive, and “a large percentage” of gynecologists will ignore ACOG’s appeal and won’t change their practices, she predicted.

“But those that are cognizant,” Sam said, “will smile and go, ‘The world is changing.’”

via Sun Sentinel

Federal health care programs pay for the implantation of the birth control device, marketed under the Mirena name by Bayer Pharmaceuticals, but manufactured in Finland by Bayer.  The payment takes into account the cost of the device from data received from manufactures.  The devices sold in the United States and in the rest of the world under the Mirena name are apparently identical products, but the packaging is slightly different.  According to the FDA and prosecutors, the different packaging, and potentially the manufacture at a non-FDA approved facility, makes the product misbranded and therefore unsafe for use in the United States although it might be identical in every other way.

Federal Health Care programs only pay claims for FDA approved devices.  Therefore, a claim made to a federal health care program for a service including the use of a non-FDA approved device may be subject to an allegation of fraud or false claims.  Also, under Florida law, the commercial purchasers of drugs and devices are required to purchase such drugs or devices from a supplier who can issue a valid audit trail, or pedigree, tracing the origins of the device from the manufacturer or purchaser.  The failure to obtain a drug or device form an appropriate source under the pedigree laws renders the product misbranded or adulterated under the law.

The first wave of enforcement in the quest by the State of Florida and the DEA to alleviate the problem of prescription drug abuse has focused largely on physicians.  Now, although the physician “pill mill” problem still receives a lot of attention, the State and DEA (while not doing victory laps yet) have cut substantially into the problem. Either by stopping or scaring out of business a large number of rouge pain management practices.

Since eliminating physician dispensing of most controlled substances through legislation, the focus of enforcement efforts by the State and DEA is turning to pharmacies, in particular those associated with pain management clinics or the dispensing of what is perceived as large quantities of oxycodone.  Although statistics show a large increase in the number of DEA license applications by pharmacies, the DEA is processing those applications very slowly, many say slowly enough to constructively deny the applications without having to go through the administrative process.   It is expensive to operate a pharmacy, and without a DEA registration, almost impossible.  So time is the regulators friend as businesses give up the process.

On the State level, pharmacies are finding their DOH inspections increasingly draconian and violations once noted on an inspection report are now causing licensing complaints.  New legislation has made applicants for pharmacy licenses subject to much greater scrutiny (F.S. 465.018(3));  pharmacies and pharmacists responsible for reporting of doctor shopping (F.S.465.015(3); new disciplinary action for failure to properly review and validate prescriptions (F.S. 465.016(1)(t))  and has made due diligence by all drug suppliers mandatory.   Although the DEA, through its own reporting mechanisms are aware of pharmacies ordering large quantities of controlled substances, the reporting of controlled substance prescribing and dispensing is now in effect and regulators will have a whole new well of information to analyze pharmacy practices.

By Bernard M. Cassidy

The most infamous example is a 2003 settlement by the hospital corporation, HCA, totaling $1.7 billion in overpayments and fines for the systematic submission of false cost reports to CMS.  The United States did attempt to prosecute several executives of one HCA hospital; however the convictions of those executives were overturned on appeal.  Interestingly, the prosecutor’s decision to narrow the scope of the allegations helped the jury convict the Defendants, but afforded the Defendants the opportunity to argue on appeal that one fraudulent submission, on its own, was merely based on a difference of opinion as to the claim rather than systematic fraud.   No one ever attempted to prosecute top-level executives of the company, which owned hundreds of hospitals and who allegedly set in place the system for the fraud.  Instead, the company was allowed to offer up a guilty plea from shell corporate subsidiaries whose only existence was to plead guilty and pay a fine.

This week, a large equipment provider, Hil-Rom, settled with the United States for $42 million related to a host of fraudulent claims, including claims for providing equipment to deceased beneficiaries.  Reportedly, the company designed its software, intentionally, to  keep billing claims for equipment unless someone stopped it.  Ordinarily, a provider who submits claims for providing equipment does so each month after supposedly making sure the patient still needs it and is still breathing.

The dollar figure alone, $42 million in false claims, would seem to evidence systematic conduct;  however the agreement somehow also affords the lawyers for the provider to issue a statement saying the company did nothing wrong.  At the same time, the company remains a provider.  Two individuals, who will likely not be receiving employee of the month awards, reported the activity and stand to split $8 million.

By Bernard M. Cassidy

In this case, the two defendants pled guilty without a trial and without a plea agreement with the government.  In federal criminal prosecutions, defendants who plead guilty generally do so through plea agreements with prosecutors.  However, there are occasions where such an agreement waives appeal rights or commits a defendant to agree to facts they may not be comfortable with, including in many cases, the level of involvement in the crime or the amount of money at issue.

Why those things can be very significant is that judges are guided in sentencing defendants by the Federal Sentencing Guidelines.  The Guidelines provide what is essentially a score sheet for various offenses with adjustments based on various criteria, including the role in the crime and the “amount of loss” incurred in a scheme.  In many instances, the number of crimes a defendant pleads guilty to is not as important as the type of crime and the amount of loss or other adjustment.

However, regardless of the terms of the plea agreement and the Guidelines, federal judges can sentence defendants who plead guilty to any sentence authorized under the law.  Judges are authorized to sentence defendants to the maximum amount of time under the law for all of the crimes added together; which can add up with 10 or 20 years per crime.  A defendant pleading guilty is taking on faith that the judge will honor the Guidelines or the plea agreement. In most instances, judges do.

In this case, it appears that the attorneys for the defendants felt they could not agree with the terms of the proposed plea agreement. Either the amount at issue or some other component of the plea agreement.  Believing they stood a better chance with the court in arguing these issues, the defendants plead guilty without a plea agreement. It appears the judge was unconvinced, and without any agreement to even consider, sentenced the defendants to an extremely large sentence.

via WPTV

In 2011, the Florida Legislature passed a law which prohibited physicians from inquiring into gun ownership. The law, “Firearm Owners’ Privacy Act”  Fla. Stats. §§ 790.338, 381.026, 456.072, 395.1055).  Under the law, licensed health care practitioners  may not (i) intentionally record any disclosed information concerning firearm ownership in a patient’s medical record if the practitioner knows the information is not relevant to the patient’s medical care or safety, or the safety of others (the “record-keeping provision”); (ii) ask a patient whether she owns a firearm unless the practitioner in good faith believes the information is relevant to the patient’s medical care or safety, or the safety of others (the “inquiry restrictionprovision”); (iii) discriminate against a patient based solely on firearm ownership. or (iv) unnecessarily harass a patient about firearm ownership.

The law, passed with the approval of the FMA was attacked in a lawsuit by a number of physician groups as an unconstitutional prohibition on free speech.  US District Court Judge Macia Cooke agreed, granting a preliminary injunction against the application of the law.  In the opinion, Judge Cooke found that the law was a direct restriction on the content of speech which is prohibited.  The State contended that the law was designed to uphold the Second Amendment, which protects the right to bear arms.  The court found that nothing in the law affected the rights of ownership, but did restrict speech about guns,which the First Amendment allows.

By Bernard Cassidy

In West Virginia, two physicians have started an advocacy group targeting physicians to pledge that their practices, in treating pain management, would not prescribe oxycodone in the course

of treatment. Citing the addiction potential for the drug and highlighting some of the more egregious cases of abusive prescribing, the physician’s pledge presents an interesting quandary.  The problem of oxycodone addiction in states like West Virginia are longstanding and well documented; in 2004, Purdue Pharma, the manufacturer of Oxycontin, settled a lawsuit with the State to settle claims that the company negligently marketed the drug, causing substantial addiction in the State. The slang term for the drug, Hillbilly Heroin, comes from the fact of such a problem.  However, if a physician chooses to eliminate from consideration a course or method of treatment which is an option, is that physician merely being reactionary at the expense of patient care?

Attempts to actually ban oxycodone is not a new idea.  However, it is somewhat unusual for a push to come from the physician community.  More likely to happen is that recently, the DEA and FDA have proposed regulations requiring mandatory additional training for physicians in order to obtain DEA prescribing privileges for opioid medications.  The FDA has already promulgated regulations requiring manufacturers of certain narcotics to make such training available to physicians.

By Bernard Cassidy

In any given year, the study found 7.4 percent of doctors faced a claim.

Most of the suits did not result in payment — only about 1 in 5 claims led to a monetary settlement. The study also did not suggest the claims were in any way frivolous.

However, the authors said the sheer frequency of claims could account for “intense pressure to practice defensive medicine.” They said doctors can insure against indemnity payments, but that they still face “the indirect costs of litigation, such as time, stress, added work, and reputational damage.”

Lawmakers often blame defensive medicine — the ordering of extra tests and procedures to protect a doctor against possible suit — for the rising cost of health care.

Medical malpractice reform was largely overlooked in the crafting of the federal health care overhaul, though President Obama said earlier this year that he’s open to tort reform to “rein in frivolous lawsuits.”

Read more: http://www.foxnews.com/politics/2011/08/19/study-most-doctors-will-face-malpractice-suit-during-career/#ixzz1VybFC2KQ

via(foxnews.com)