Federal Investigation

[anonymous]

So, how can a healthcare director of billing be an executive of a lab, and state there is no conflict of interest? How can billing for labs, physician care, and pharmacy be done in one place, same billers, and there is no conflict of interest.

even better: why is the compliancy officer asking staff to lie to get information? that is how the code of conduct is just a piece of paper-toilet paper. bet the compliancy officer won't be on the next lay off list, though.

 

[anonymous]

what i was pointing out - unless a physician has signed a waiver for the specific representative to have access to patient information - access is not allowed.

 

[anonymous]

I was also a former Cordant/Sterling employee. I was also let go and was made to sign an agreement to not provide information as a whistleblower. I needed my severance and therefore signed the agreement. I do have information on the company and several clients where violations of interest to both the DOJ and FBI would be of interest. I recently filed a complaint with the OIG in hopes of putting a stop to their business practices.

I would recommend investigating Dr.Frank Kunkle in PA. As a client of Cordant, numerous kick back arrangements and business schemes were provided. Cordant has engaged in a number of highly unethical business arrangements beyond this one individual physician, including use of 1099 reps who were permitted to sell urine UDT cups to physician offices. The investors/owners are equally corrupt.

Signing that agreement does not protect them, and does not keep you from filing a complaint. DOJ would very much love for them to come after you for this, if your information provides information they can use to recover money from ill gotten gains. Having given DOJ information myself, after signing a document very similar, elicited this response. "Please produce your separation agreement." They thought it very odd, because why have such a clause in your separation agreement, unless they thought they were doing something odd. No company can compel you to break the law, or retain information of them breaking the law, especially when the Federal Government is paying them with our tax dollars.

 

[anonymous]

I just googles NW Physicians Lab because I recently received a bill from them. It is strange because for the number of years my physician has used them, I occasionally received EOB's from my insurance for thousands of dollars (out of network) which I was told to ignore. This is the first time I have been billed from them and the statement makes me uneasy. The ink is funky and the itemization is confusing. It is very specific and charges are steep. Anyhow, I don't know whether to pay it or report it.

 

[anonymous]

Signing that agreement does not protect them, and does not keep you from filing a complaint. DOJ would very much love for them to come after you for this, if your information provides information they can use to recover money from ill gotten gains. Having given DOJ information myself, after signing a document very similar, elicited this response. "Please produce your separation agreement." They thought it very odd, because why have such a clause in your separation agreement, unless they thought they were doing something odd. No company can compel you to break the law, or retain information of them breaking the law, especially when the Federal Government is paying them with our tax dollars.

 

[anonymous]

Cordant Health Solutions asks separated employees to sign an obscene document trying to clear the lab of any wrong doing. The document may not hold up in court, however, how many departed employees did not sign it? How many left money on the table because signing ran completely counter to the former employees' knowledge, beliefs or values? Would an ethical company do this?
The DOD and DOJ ought to talk with employees who did not sign the offensive document, as well as those who did.

 

[slipperyslope]

Well if you are a disgruntled and want ammunition: just think about every time a patients test results gets transmitted to a rep without any modifications to hide patient information & that rep brings the information into an office. . . .

HIPAA Privacy Rules for the Protection of Health and Mental Health Information
(Note: The information provided below is a summary and intended for general informational purposes. Mental health providers and other covered entities should not rely on this summary as a source of legal information or advice and should consult with their own attorney or HIPAA Privacy Officer for specific guidance.)

Introduction:

This document provides guidance about key elements of the requirements of the Health Insurance Portability and Accountability Act (HIPAA), federal legislation passed in 1996 which requires providers of health care (including mental health care) to ensure the privacy of patient records and health information. HIPAA required the federal Department of Health and Human Services (HHS) to develop regulations to implement these privacy requirements, called the Privacy Rule, which became effective on April 14, 2003. State statutes which provide more stringent protections of health care privacy remain in effect even after HIPAA, and therefore this document includes a few relevant references to requirements in New York State's mental health confidentiality statute (section 33.13 of the Mental Hygiene Law).

General:

The HIPAA Privacy Rule (45 CFR Parts 160 and 164) provides the first comprehensive Federal protection for the privacy of health and mental health information. The Rule is intended to provide strong legal protections to ensure the privacy of individual health information, without interfering with patient access to treatment, health care operations, or quality of care.

The Privacy Rule applies to “covered entities” which generally includes health plans and health care providers who transmit health information in electronic form. Covered entities include almost all health and mental health care providers, whether they are outpatient, residential or inpatient providers, as well as other persons or organizations that bill or are paid for health care.

Basic Principles of the Privacy Rule:

1. The Privacy Rule protects all “protected health information” (PHI), including individually identifiable health or mental health information held or transmitted by a covered entity in any format, including electronic, paper, or oral statements.
2. A major purpose of the Privacy Rule is to define and limit the circumstances under which an individual's PHI may be used or disclosed by covered entities. Generally, a covered entity may not use or disclose PHI to others, except:
   1. as the Privacy Rule permits or requires; or
   2. as authorized by the person (or personal representative) who is the subject of the health information. A HIPAA-compliant Authorization must contain specific information required by the Privacy Rules.
3. A covered entity must provide individuals (or their personal representatives) with access to their own PHI (unless there are permitted grounds for denial), and must provide an accounting of the disclosures of their PHI to others, upon their request.
4. The Privacy Rule supersedes State law, but State laws which provide greater privacy protections or which give individuals greater access to their own PHI remain in effect.

(Note: One must consult not only HIPAA but also other relevant federal privacy laws (such as regulations pertaining to Medicaid and federally funded substance abuse treatment programs), as well as State privacy laws (including the Mental Hygiene Law- section 33.13, the Public Health Law, the Education Law licensing provisions, and the Civil Practice Laws and Rules), to determine whether a disclosure of medical information is permissible in a given circumstance.)

Permitted Uses or Disclosures of PHI Without Authorization:

Extensive provisions of the Privacy Rule describe circumstances under which covered entities are permitted to use or disclose PHI, without the authorization of the individual who is the subject of the protected information. These purposes include, but are not limited to, the following:

1. A covered entity may disclose PHI to the individual who is the subject of the information.
2. A covered entity may use and disclose protected health information for its own “treatment, payment, and health care operations.”
   1. Treatment is the provision, coordination, or management of health care and related services for an individual, including consultation between providers and referral of an individual to another provider for health care.
   2. Payment includes activities of a health care provider to obtain payment or to receive reimbursement for the provision of health care to an individual.
   3. Health care operations include functions such as: (a) quality assessment and improvement; (b) competency assessment,, including performance evaluation, credentialing, and accreditation; (c) medical reviews, audits, or legal services; (d) specified insurance functions; and (e) business planning, management, and general administration.
3. Permission may be obtained from the individual who is the subject of the information or by circumstances that clearly indicate an individual with capacity has the opportunity to object to the disclosure but does not express an objection. Providers may also rely on an individual's informal permission to disclose health information to an individual's family, relatives, close personal friends, or to other persons identified by the individual, limited to information directly related to such person's involvement.
4. When an individual is incapacitated or in an emergency, providers sometimes may use or disclose PHI, without authorization, when it is in the best interests of the individual, as determined by health care provider in the exercise of clinical judgment. The PHIthat may be disclosed under this provision includes the patient's name, location in a health care provider's facility, and limited and general information regarding the person's condition.
5. Providers may use and disclose PHI without a person's authorization when the use or disclosure of PHI is required by law, including State statute or court order.
6. Providers generally may disclose PHI to State and Federal public health authorities to prevent or control disease, injury, or disability, and to government authorities authorized to receive reports of child abuse and neglect.
7. Providers may disclose PHI to appropriate government authorities in limited circumstances regarding victims of abuse, neglect, or domestic violence.
8. Providers may disclose PHI to health oversight agencies, (e.g., the government agency which licenses the provider), for legally authorized health oversight activities, such as audits and investigations.
9. PHI may be disclosed in a judicial or administrative proceeding if the request is pursuant to a court order, subpoena, or other lawful process (note that "more stringent" NYS Mental Hygiene law requires a court order for disclosure of mental health information in these circumstances).
10. Providers may generally disclose PHI to law enforcement when:
    1. Required by law, or pursuant to a court order, subpoena, or an “administrative request,” such as a subpoena or summons (Note: the "more stringent" NYS Mental Hygiene Law section 33.13 requires a court order for disclosure of mental health information in these circumstances). The information sought must be relevant and limited to the inquiry.
    2. To identify or locate a suspect, fugitive, material witness or missing person (Note: under Mental Hygiene Law section 33.13 this information is limited to “identifying data concerning hospitalization”).
    3. In response to a law enforcement request for information about a victim of a crime (Note: under Mental Hygiene Law section 33.13 this information is limited to “identifying data concerning hospitalization”).
    4. To alert law enforcement about criminal conduct on the premises of a HIPAA covered entity.
11. Providers may disclose PHI that they believe necessary to prevent or lessen a
    1. serious and imminent physical threat to a person or the public, when such disclosure is made to someone they believe can prevent or lessen the threat (including the target of the threat).
12. An authorization is not required to use or disclose PHI to certain government
    1. programs providing public benefits or for enrollment in government benefit
    2. programs if the sharing of information is required or expressly authorized by statute or regulation, or other limited circumstances

The Hippa angle is interesting.

The terms used and disclosed stand out to me.

I have been able to view PHI of patients, then turn it to Provider to use.