Cleveland Law Library Weblog

Final HIPAA Regulations on NonDiscrimination

Final HIPPA regulations were issued concerning nondiscrimination provisions, including specific regulations on nondiscrimination in employee wellness programs. See 71 FR 75014.  Generally, the HIPAA nondiscrimination provisions provide that group health plans and group health insurers may not discriminate against a participant or beneficiary based on any health factor of a participant or beneficiary.  The supplemental information in the Federal Register section compares the prior interim and proposed regulations to the final regs.

The effective date of the regulations is February 12, 2007.  The regs apply to plan years beginning on or after July 1, 2007.

Source:  Final HIPPA Nondicriminatory/Wellness Program Rules by Chuck Kallendorf, Cincinnati Law Library Blog, Dec. 12, 2006. 

Resources for Setting Up a Concierge Medical Practice

A concierge medical practice, also called a boutique medical practice,  involves patients paying  a retainer to receive medical care over a certain period.  Benefits to patients may include no waiting for appointments, house calls, periodic wellness checkups and generally more personal attention.  Conversion to a concierge practice, if not done properly, may lead to allegations of abandonment.  There are also issues of how a concierge practice can comply with Medicare requirements.

Here are some articles which may be helpful in setting up a concierge practice: Warner, Norcross and Judd, L.L.P. Articles, including Legal Issues Involved in Concierge Medical Practices by John R. Marquis, March 2005; Retainer Medicine, May 16, 2006 (On the Washington State Insurance Commissioner's page); The Steady Creep Towards Concierge Medicine by Joseph V. Geraci, Brown McCarroll LLP, Nov. 14, 2005; The Legal Risks of Boutique Medicine by Steven M. Goldstein, Sacks-Tierney, P.A., July 2003;  Download retainer_practices_discussion_paper.doc , by the American Academy of Family Physicians, 2006; How to Set Up a Concierge Practice by Wayne J. Guglielmo,  Medical Economics, Aug. 22, 2003.  

There are forms available for a fee on the web, including patient contracts:  Concierge or Retainer Medical Practice - How to Evaluate and Start a Retainer Practice , 2004, Health Care Intelligence Network; Concierge or Retainer Medical Practice - How to Evaluate and Start A Retainer Practice 2006 by Apollo Managed Care Consultants.   

Hospital Reporting Act Makes Cost and Quality Info Available on the Web

A new Ohio law, H.B. 197, requires hospitals to submit quality of care and cost information to the Ohio Department of Health.  The Department of Health will make the information available on its website.  Ohio Gets Hospital Reporting Law , United Press International, Aug. 9, 2006.  See also: Hospital Data Reporting Law Passed by Chad W. Helmick, Schottenstein, Zox & Dunn, Aug. 11, 2006. 

Teachers Win $7.8 Million in Fraud Suit Against Pharmacy Benefit Manager

The State Teachers Retirement System sued Merck and its subsidiary Medco Health Systems for fraud and breach of fiduciary duty while managing the retired teachers' pharmacy benefit plan.  STRS alleged that the defendants overcharged for certain drugs and dispensing fees and wrongfully withheld manufacturer's rebates. See Ohio Attorney General's Press Release, Petro Wins $7.8 Million Verdict Against Merck, Medco For Defrauding Teachers’ Pension System Dec. 20, 2005;  Jury Awards $7.8M in Teachers' Fraud Suit Times Daily, December 20, 2005.  To view documents in the case go to: Board of the State Teachers Retirement System of Ohio vs. Medco Health Solutions, Inc. , Hamilton County Common Pleas Court Case No A 0309929.

Hospital Entitled to Immunity for Doctor's Suspension

The Eighth District Court of Appeals held that a hospital was entitled to immunity for a doctor's claims of breach of contract, tortious interference with business, fraud and other claims.  The doctor claimed he was wrongfully suspended after a peer review.  Applying federal case law, the court found that the hospital performed a "qualified profession review action", and was thus immune from suit under the Health Care Quality Improvement Act.   See Fox v. Parma Community General Hospital, 2005 Ohio 1665.