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A hospital being sued by its own risk manager is deep trouble, says Barbara E. Hoey, JD, a shareholder with the law firm of Littler Mendelson in New York City.
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The government's health care fraud prevention and enforcement efforts recovered nearly $4.1 billion in taxpayer dollars in 2011, the highest annual amount ever recovered.
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Healthcare providers have been subject to the volatility of the insurance market for years, which has led some to look to the idea of establishing a captive as a way to cut costs, particularly with workers' compensation coverage. A captive can be a great solution in some circumstances, but don't jump without looking first.
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Healthcare leaders have to worry about complying with plenty of industry-specific requirements and the potential cost when a whistleblower reports malfeasance. Another risk, however, comes from the broader world of corporate fraud.
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Captive insurance agencies require the insured to take on more claims risk, but that risk is not unlimited. Even with a captive, you don't risk paying entirely out of pocket for a major claim or repeated claims in one year, says Christopher M. Keith, a producer with The Graham Co. in Philadelphia.
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Why should a patient's electronic health record (EHR) be stored on-site, when the records can be cost effectively stored on the Internet at a remote location? This question is posed by Bernard Rosof, MD, MACP, CEO of the Quality in Healthcare Advisory Group, a consulting firm in Huntington, NY.
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Health Management Associates (HMA) shareholders filed a class action in Florida federal court recently and claimed stock prices dropped after it was revealed the hospital group had used Medicare fraud to inflate prices and hidden a wrongful-termination whistleblower suit by an employee who uncovered the alleged fraud.
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Security is a major concern for healthcare providers using the cloud, says Paul Rubell, JD, partner in the Corporate Law Group at the law firm of Meltzer Lippe Goldstein & Breitstone in Mineola, NY.
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The Securities and Exchange Commission (SEC) Whistleblower Program was created in Section 922 of the Dodd-Frank Wall Street Reform and Consumer Protection Act of 2011.
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Captive insurance companies aren't for everyone, says Timothy E.J. Folk, vice president with The Graham Co., a healthcare consulting company in Philadelphia.
