This document discusses various legal issues related to revenue cycle management. It addresses questions around charging patients for missed appointments, ensuring written notification of policies, and considerations for reasonable amounts. It also covers issues like employing and securing data for remote workers, handling restrictively endorsed checks, and implications of the IRS 501(r) rule for billing and collections. The document provides overviews and checklists to help navigate complex areas of compliance.
The 16th Annual Seminar on Professional Responsibility was presented on October 11, 2013, and offered 2.75 CLE credits to attendees. The seminar covered topics regarding ethics and professionalism, including: duties to prospective clients; tips to avoid ethical and malpractice traps; blogging in the digital age; and substance abuse.
This document summarizes information related to resolving liens from the Pennsylvania Department of Public Welfare (DPW). It discusses DPW's responsibilities to provide notice when a claim is beginning and being settled. It provides details on what to include in notice letters to DPW. It also discusses strategies for disputing medical expenses claimed by DPW, such as only including related treatment in settlement demands. Ethics rules on expediting litigation and client confidentiality are reviewed. Options for special needs trusts are presented for clients requiring long-term care.
This settlement agreement resolves a debt of $[amount] owed by [Entities] to Hwacheon Machinery America for machinery and parts delivered between 2007-2009. [Entities] will make an initial payment of $[amount] and then 15 monthly payments of $[amount]. If any payment is late, interest accrues at 5% and the agreement allows for default and enforcement of a stipulated judgment if [Entities] misses a payment. The agreement provides forbearance on enforcing the judgment as long as payments are made.
The document discusses fraudulent conveyance law and how it may impact estate planning. It summarizes a case that established intent to avoid creditors as the key element, even without dishonest intent. Later cases confirmed this, finding transactions void if one purpose was creditor avoidance. The document advises being aware of potential challenges under this law and taking proactive steps like involving family, documenting reasons for transactions, and ensuring future creditors know the financial situation.
Judge Posner Dismisses "Frivolous" Appeal of Contempt Order in Subrogation Ca...NationalUnderwriter
From FC&S Legal: Judge Posner Dismisses "Frivolous" Appeal of Contempt Order in Subrogation Case and Orders District Court to Consider Whether Lawyer and Client Should Be Jailed
Judge Richard Posner of the U.S. Court of Appeals for the Seventh Circuit has written the opinion for a panel of three judges dismissing a “frivolous” appeal by a lawyer and his client from a district court order holding them in contempt in a subrogation case.
The Case
As Judge Posner explained, Beverly Lewis was injured in an automobile accident in Georgia and her health plan paid approximately $180,000 for the cost of her medical treatment. Represented by Georgia lawyer David T. Lashgari, Ms. Lewis brought a tort suit in Georgia state court against the driver of the car involved in the accident (her son-in-law), and obtained a $500,000 settlement. The health plan had, and, Judge Posner wrote, Mr. Lashgari “knew it had,” a subrogation lien that granted it the right to offset the cost that the plan had incurred as a result of the accident against any money that Ms. Lewis obtained in a suit arising out of the accident.
The 16th Annual Seminar on Professional Responsibility was presented on October 11, 2013, and offered 2.75 CLE credits to attendees. The seminar covered topics regarding ethics and professionalism, including: duties to prospective clients; tips to avoid ethical and malpractice traps; blogging in the digital age; and substance abuse.
This document summarizes information related to resolving liens from the Pennsylvania Department of Public Welfare (DPW). It discusses DPW's responsibilities to provide notice when a claim is beginning and being settled. It provides details on what to include in notice letters to DPW. It also discusses strategies for disputing medical expenses claimed by DPW, such as only including related treatment in settlement demands. Ethics rules on expediting litigation and client confidentiality are reviewed. Options for special needs trusts are presented for clients requiring long-term care.
This settlement agreement resolves a debt of $[amount] owed by [Entities] to Hwacheon Machinery America for machinery and parts delivered between 2007-2009. [Entities] will make an initial payment of $[amount] and then 15 monthly payments of $[amount]. If any payment is late, interest accrues at 5% and the agreement allows for default and enforcement of a stipulated judgment if [Entities] misses a payment. The agreement provides forbearance on enforcing the judgment as long as payments are made.
The document discusses fraudulent conveyance law and how it may impact estate planning. It summarizes a case that established intent to avoid creditors as the key element, even without dishonest intent. Later cases confirmed this, finding transactions void if one purpose was creditor avoidance. The document advises being aware of potential challenges under this law and taking proactive steps like involving family, documenting reasons for transactions, and ensuring future creditors know the financial situation.
Judge Posner Dismisses "Frivolous" Appeal of Contempt Order in Subrogation Ca...NationalUnderwriter
From FC&S Legal: Judge Posner Dismisses "Frivolous" Appeal of Contempt Order in Subrogation Case and Orders District Court to Consider Whether Lawyer and Client Should Be Jailed
Judge Richard Posner of the U.S. Court of Appeals for the Seventh Circuit has written the opinion for a panel of three judges dismissing a “frivolous” appeal by a lawyer and his client from a district court order holding them in contempt in a subrogation case.
The Case
As Judge Posner explained, Beverly Lewis was injured in an automobile accident in Georgia and her health plan paid approximately $180,000 for the cost of her medical treatment. Represented by Georgia lawyer David T. Lashgari, Ms. Lewis brought a tort suit in Georgia state court against the driver of the car involved in the accident (her son-in-law), and obtained a $500,000 settlement. The health plan had, and, Judge Posner wrote, Mr. Lashgari “knew it had,” a subrogation lien that granted it the right to offset the cost that the plan had incurred as a result of the accident against any money that Ms. Lewis obtained in a suit arising out of the accident.
The document summarizes two major legal issues facing hospital billing offices: TCPA and IRS 501(r). TCPA prohibits automatic dialing to cell phones without consent and has generated lawsuits, so hospitals must get express consent in admissions forms. IRS 501(r) is complex and revamps billing/collection by prohibiting extraordinary collection actions without determining financial assistance eligibility, and imposing reasonable efforts, notification periods, and processes around suspending collections and determining/reversing actions for eligible patients.
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Under the Insolvency Law, the Debtor needs to attend court. Here, he places a
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The Division of Florida Condominiums handles complaints regarding violations of condominium laws. It will accept complaints that allege specific violations, provide supporting documentation, and address issues within its jurisdiction. Accepted complaints are assigned to investigators who will contact the complainant for more details and determine if a violation occurred. The Division aims to resolve complaints through education and may take enforcement actions if warranted based on the alleged violation and association's compliance history.
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Unless you stay current on billing issues and love doing it, this webinar will help you… a busy professional who provides great care but also knows that getting paid for it is pretty important.
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Similar to REVENUE CYCLE LEGAL ISSUES Oregon HFMA Feb. 19, 2015 (20)
1. REVENUE CYCLE LEGAL ISSUES
Presented by:
Adam L. Plotkin, Principal/General Counsel
Healthcare Outsourcing Network, L.L.C.
aplotkin@outsourcingnetwork.com
2. The Law
• “The minute you
read something that
you can't
understand, you can
almost be sure that
it was drawn up by a
lawyer. “
--Will Rogers
3. Patient No-Shows
• Can we charge the
patient?
• Should we?
• How much?
• Lack of service to
patient vs. lost
revenue to provider
4. Put it in writing!!!!
Is verbal notification of
no-show charge policy
enough?
Issues of proof at trial
PR issues
5. If you want to charge for no-shows:
Checklist
• Have a signed, dated
agreement from the
patient in the file.
• The document
should expressly
state the
cancellation terms.
• The document
should expressly
state the exact
amount of the no-
show charge.
• Be reasonable in
what you charge!
6. Other Considerations
• Do you charge for a first missed appointment?
• Do you base the charge upon the length of
time set for the appointment?
• Do you post a sign regarding your no-show
policy?
• Do you continue to treat chronic no-show
patients?
7. The “Newly Unemployed”
• Who are they?
• Unprecedented levels of long-term
unemployment.
• A self-pay opportunity?
• Strategies.
8. Telecommuters/Laptops
• Should you allow people to
work from home
(telecommute)?
• Should you allow office staff
to use laptops?
• HIPAA issues:
– Security, control, and
supervision
9. Theft of Data
• An increasingly common problem!
• No longer any need for employees to
have sensitive data off-site.
– Secure VPN, all data remains on
servers.
• If you disagree, at least take steps to
secure data:
– Encryption;
– Biometrics;
– Smart cards.
10. Some Gov’t. Guidance
• http://www.cms.hhs.gov/SecurityStandard/D
ownloads/SecurityGuidanceforRemoteUseFin
al122806.pdf
11. Key Legal Issues
• Supervision of
telecommuters
• How do you ensure
compliance with
various laws?
• Interplay with HIPAA
– Privacy Standard
– Security Standard
13. § 3-311. ACCORD AND SATISFACTION BY
USE OF INSTRUMENT
• (a) If a person against whom a claim is asserted
proves that (i) that person in good faith tendered an
instrument to the claimant as full satisfaction of the
claim, (ii) the amount of the claim was unliquidated
or subject to a bona fide dispute, and (iii) the
claimant obtained payment of the instrument, the
following subsections apply.
14. U.C.C. §3-311
• (b) Unless subsection (c) applies, the claim is discharged if
the person against whom the claim is asserted proves that
the instrument or an accompanying written communication
contained a conspicuous statement to the effect that the
instrument was tendered as full satisfaction of the claim.
• (c) Subject to subsection (d), a claim is not discharged
under subsection (b) if either of the following applies:
– (1) The claimant, if an organization, proves that (i) within
a reasonable time before the tender, the claimant sent a
conspicuous statement to the person against whom the
claim is asserted that communications concerning
disputed debts, including an instrument tendered as full
satisfaction of a debt, are to be sent to a designated
person, office, or place, and (ii) the instrument or
accompanying communication was not received by that
designated person, office, or place.
15. U.C.C. §3-311
• (2) The claimant, whether or not an organization, proves that
within 90 days after payment of the instrument, the claimant
tendered repayment of the amount of the instrument to the
person against whom the claim is asserted. This paragraph
does not apply if the claimant is an organization that sent a
statement complying with paragraph (1)(i).
• (d) A claim is discharged if the person against whom the claim
is asserted proves that within a reasonable time before
collection of the instrument was initiated, the claimant, or an
agent of the claimant having direct responsibility with respect
to the disputed obligation, knew that the instrument was
tendered in full satisfaction of the claim.
16. Problems
• What is good faith?
• What is a bona fide dispute?
• What is conspicuous?
• Who is an “agent of the claimant having direct
responsibility with respect to the disputed
obligation”?
• Remember—this is a model law, NOT a federal
law!
• All 50 states have their own version of U.C.C. §3-
311.
17. So what do we do??????
• The most risk averse course: if you would not
be happy with writing off the remaining
balance, return the check to the sender.
18. But…I want ALL of my money!
• Well, if you insist, then there are a few items
to consider.
Thisisa personal reminder from
people who have bent over backwards
to fullfill their obligation to you and are
awaiting action on your end.
Thankyou.
The Management
19. Checklist
• What does your state law say?
– Depending upon your state law and the facts of
your situation, you may be bound to accept the
amount tendered.
• Assuming your state law follows the UCC:
– Has the patient acted in good faith?
– Is there a bona fide dispute?
– Was there a conspicuous statement re settlement?
20. Checklist (continued)
• Prior to receipt of the payment, had you sent
a conspicuous statement that any payment
tendered in full settlement had to be sent to a
designated person, office, or place?
• Did the patient follow this direction?
• Was payment refunded with applicable
timeframe?
• Did you or an authorized agent know the amount
was tendered in full settlement?
21. Implied Contracts
• Patient has a $5,000.00 account.
• Patient sends $5.00.
• You call and demand larger payments.
• Patient says you must accept whatever I
send—that is what “THE LAW” says!
• Question—what exactly is “THE LAW”?
22. Can an Implied Contract Arise?
• Yes, but certain things must occur first.
• If you accept enough regularly sent payments,
at some point, an implied contract may arise.
• Is there a magic number of payments?
– No.
23. How Many Payments?
• Depends. Check your state contract laws.
• Some general guidelines:
• If patient makes 12 consecutive monthly
payments, you may have created an implied
contract.
• Even if you have not, do you really want to
fight this scenario?
• Could be bad PR.
24. Inconsistent Payments
• What if patient makes two monthly payments
and then stops?
• No implied contract
• What if patient makes 2 monthly payments,
misses a month, makes another payment,
misses 2 months…
• Probably no implied contract.
25. IRS 501(r) Final Rule
• For our purposes today, we will focus upon
the impact on billing and collection
• Rule contains much more!
26. Billing and Collection
• Hospital may not
engage in extraordinary
collection actions
(“ECA”) prior to making
reasonable efforts to
determine whether
individual eligible for
financial assistance.
27. ECA’s
• Selling debt
– Unless: prior to sale, legally binding written
agreement:
• Prohibiting purchaser from any ECA’s;
• Prohibiting interest in excess of rate under section
6621(a)(2) at time of sale (3% when Final Rule
published);
• Debt recallable by hospital upon determination by
hospital or buyer individual FAP-eligible; AND,
28. ECA’s
• If individual determined FAP-eligible and debt
not returned to or recalled by hospital, buyer
required to adhere to procedures specified in
the agreement that ensure that individual
does not pay, the buyer and the hospital
together more than he is responsible for
paying as an FAP-eligible individual.
29. ECA’s
• Credit reporting;
• Deferring or denying, or requiring payment
before providing medically necessary care due
to prior unpaid bills for prior care under
hospital’s FAP;
• Actions that require legal or judicial process,
including but not limited to:
– Liens on property (other than state law hospital
lien, i.e., PI claims);
30. ECA’s
– Foreclosing on real property;
– Attaching or seizing bank account or other
personal property;
– Commencing a civil action;
– Causing arrest;
– Causing writ of body attachment;
– Garnishing wages
32. Reasonable Efforts
• Must refrain from ECA’s until have made
reasonable efforts to determine whether
individual is eligible for assistance under FAP.
• ECA’s engaged in, and reasonable efforts taken
to determine FAP eligibility by, “any purchaser
of the individual’s debt, any debt collection
agency or other party to which the hospital
facility has referred the individual’s debt” are
imputed to hospital.
33. Reasonable Efforts
• Notification period:
– ECA’s may begin 120 days after first post-discharge
billing statement, provided proper notification has
been given.
• Application Period:
– 240 days after first post-discharge billing
statement (possibly longer)
34. Reasonable Efforts
• Remember: all notices must inform about
availability of financial assistance under
hospital’s FAP, telephone number to obtain
info about FAP and application process, web
site address for copies of FAP, FAP application,
and plain language summary of FAP
35. Reasonable Efforts
• Notice Prior to ECA’s:
– At least 30 days prior to taking ECA’s:
• Provide written notice that financial assistance is
available to eligible individuals, identify the ECA’s that
hospital (or other authorized party) intends to take, and
states a deadline after which such ECA’s may be
initiated that is no earlier than 30 days after the date
that the written notice is provided.
36. Reasonable Efforts
• Together with the above described written notice, the
individual must also be given a plain language summary
of the FAP.
• Reasonable effort must be made to orally notify the
individual about hospital’s FAP and about how to obtain
assistance with the FAP application process.
• Oral notification:
– How do we do this?
37. Interplay of 120 and 240 Day
Timeframes
• Can we initiate ECA’s prior to 240 days?
• What if FAP application submitted after 120
days, but before 240 days?
• Suspension of ECA’s once FAP application
submitted
– Incomplete applications
• Suspend ECA’s
• Notice of additional info required
38. Interplay of 120 and 240 Day
Timeframes
– Complete applications
• Suspend ECA’s
• Determine whether individual FAP-eligible, notify of
determination, and basis for determination
• If individual FAP-eligible:
– If eligible for assistance other than free care, provide billing
statement for what is owed as FAP-eligible individual, how
amount was determined, and state Amounts Generally Billed
(“AGB”) or describe how individual can get info on AGB
– Refund any amount paid to hospital or any other party
exceeding amount responsible for as FAP-eligible individual
– Take all reasonably available measures to reverse ECA’s
39. Obamacare
• SCOTUS ruling:
– It survived. Sort of…
– Fails under Commerce Clause, but
survives as a tax
• The wildcard:
– States may now opt out of
Medicaid expansion
• The Exchanges
• Funding
40. Back to the SCOTUS
• Subsidies
• Are they legal?
• State v federal exchanges
• What are the
arguments?
• What will happen?
41. TCPA
• Contains a general prohibition against using
an automatic telephone dialing system or an
artificial or prerecorded message to call a
wireless number.
• With the proliferation of cell phone, this is a
problem.
• More Americans who only use cell phones—
cell phone is their home phone.
42. Consent Exception
• With patient’s consent, can place these calls
to cell phone.
• FCC: if the called party gave the wireless
number to the creditor in connection with an
existing debt, then consent exists.
• http://fjallfoss.fcc.gov/edocs_public/attachma
tch/FCC-07-232A1.pdf
• A MUST read!
43. Key Step to Take
• Have an express consent provision drafted
into your Conditions of Admission form. See,
Footnote 37 of FCC Order.
44. BEWARE!
• “Similarly, a creditor on whose behalf an
autodialed or prerecorded message call is
made to a wireless number bears the
responsibility for any violation of the
Commission’s rules. Calls placed by a third
party collector on behalf of that creditor are
treated as if the creditor itself placed the call.”
FCC Order, p. 7, ¶10.
45. Court Victories
• Our firm obtained a ruling in Sanchez v.
Continental Service Group, Inc., Case No. CV-
2009-13437 holding that debt collection calls
are exempt from the TCPA.
– See also, Meadows v. Franklin Collection Services,
2010 U.S. Dist. Lexis 72340 (N.D. Al. 2010)
– Compare, Watson v. NCO Group, Inc., 462 F.Supp.
641 (E.D. Pa. 2006)
46. February 15, 2012 FCC Ruling
• Non-telemarketing calls do not prior express
written consent.
• Non-telemarketing calls do not prior express
written consent.
• Leaves in place prior oral or written consent
standard that allows for a wireless number to
be provided to a third-party agency from their
creditor client as a contact to which the
consumer has consented.
47. Time-barred Debt
• New Mexico Attorney General entered settlement agreement
with a debt collector regarding collection of time-barred debts
• Settlement agreement requires the debt collector to provide
notifications to the consumer that the debt is time-barred and
unenforceable
• Settlement does not prohibit pursuing collection of time-
barred debts
• New Mexico Attorney General stated he is planning to pursue
action against collectors engaging in similar activities
• Consult with legal counsel before collecting time-barred debt
in New Mexico
48. ABN’s
• Advance Beneficiary Notice
• Written notice that:
• Medicare may deny payment for that specific
procedure or treatment;
• You will be personally responsible for full
payment if Medicare denies payment.
49. ABN Form
• 2 options for patient:
• If choose to receive
items or services,
check appropriate
option, sign and date
form.
• Claim will be sent
MCRE.
50. If patient wants services:
• Patient may be billed
while claim pending
with MCRE.
• If MCRE does pay,
patient refunded any
payments.
• If MCRE denies,
patient responsible
for full charge.
• Patient may appeal
MCRE decision.
51. If patient does not want services:
• Patient must check
appropriate option,
sign and date form.
• Claim will not be
sent to MCRE.
52. Important items:
• If patient signs ABN and MCRE does not cover
claim, MCRE fee schedule amounts and
balance billing limits do not apply.
• If you do not have a signed ABN from patient
and MCRE denies claim, you must write off
the claim and patient may not be charged.
– Exception: statutorily excluded items such as
cosmetic surgery.
53. What Would President Plotkin
Have Done?????
• Allow so-called association health plans.
• Allow purchase of insurance across state lines.
• Include at least some element of tort reform.
• Deal with pre-existing condition denials—
here’s how!
54. Hospital Liens
• EXTREMELY powerful tools for hospitals!
• State law creatures, so the existence,
applicability, and use of hospital liens varies
from state to state.
55. Colorado—a Sample Hospital Lien
Statute
• The Colorado Hospital Lien Statue (the
“CHLS”) is codified at C.R.S. §38-27-101 et
seq. It applies to medical services rendered to
an individual who was injured through the
negligent or wrongful acts of a third party.
• CHLS does not apply to Colorado Workers’
Compensation Act cases.
• Lien subordinate to statutory attorney liens.
56. Applicability
• Lien attaches to “all reasonable and necessary
charges for hospital care upon the net amount
payable to such injured person, his heirs,
assigns, or legal representatives out of the
total amount of any recovery or sum had or
collected, or to be collected, whether by
judgment, settlement, or compromise, by such
person, his heirs, or legal representatives as
damages on account of such injuries.”
57. Key Issues
• Identifying those patients whose hospital bills
are subject to the CHLS.
–If possible, do at the patient intake level.
–Red flags to look for.
• What information should be collected.
• Should liens be handled in-house or through
an attorney?
–Time and staffing considerations.
58. Key Issues
• Proper filing and notice of lien
–File with Secretary of State, then must send
notice via certified mail, return receipt
requested to all interested parties.
–Notice requirement can also be satisfied by
filing notice of lien in pending litigation with
copies to counsel of record for the parties.
59. Proper Filing of Hospital Lien
• http://www.sos.state.co.us/pubs/business/pd
f/form054.pdf
• May be filled out online
60.
61. Key Issues
–Risk of patient settling claim without
need to file a suit.
• Letters of protection/assignments
• Privacy considerations.
• Monitoring the liens.
–Scanning court dockets.
–Questioning patient or attorney after
discharge.
63. Enforcement of Liens
• Any person or corporation who pays money to
an injured person in violation of a validly filed
lien is liable to the hospital holding such lien
for the amount of the payment.
• Suit must be commenced within 1 year of the
payment violating the lien.
• Court shall award the hospital reasonable
attorney’s fees for enforcement action.
64. Itemized Statement Requests
• “Upon receipt of a written request mailed by
certified mail, return receipt requested, from
any person notified of such lien in accordance
with the provisions of section 38-27-102, such
hospital shall, within ten days after receipt of
such request, furnish such person with an
itemized statement of all charges for which
the lien is claimed.”
65. Assignment
• Statute expressly allows assignment of
hospital liens.
• Statute requires assignment to be in writing.
• Colorado case law also allows written
assignment.
• “Common fund” claims.
• See, Trevino v. HHL, 945 P.2d 1345 (Colo.
1997)
66. Checklist:
• Does your state have a hospital lien statute?
• Was the injury due to acts of a third-party?
• Has all necessary information been collected?
• Has the lien been properly filed?
• Has a system for monitoring the lien been
established?
67. Issues Re Hospital Liens
• Can you use them?
• Can you refrain from billing insurance in favor
of filing a hospital lien?
• Common Fund Doctrine
68. Credit Reporting Under FACTA
• Amendments to the Fair Credit Reporting Act (the
“FCRA”)
• The Fair and Accurate Credit Transactions Act
(“FACTA”)
69. Medical Information Under FACTA
• §623(a)(9)
• A person whose primary business is providing
medical services, products or devices, or the
person’s agent or assignee, who furnishes
information to a credit bureau on a consumer
shall be considered a medical information
furnisher and shall notify the credit bureau of
such status.
70. Medical Information Under FACTA
• FACTA expands the FCRA’s definition of
“medical information” to include information
or data that relates to “the payment for the
provision of health care to an individual.”
• FACTA also restricts how a medical
information furnisher or its agent reports
information relating to payment.
71. Medical Information Under FACTA
• Under FACTA, the name, address, and telephone
number of a medical information furnisher will
no longer appear in credit reports unless: “such
name, address and telephone number are
restricted or reported using codes that do not
identify, or provide information sufficient to
infer, the specific provider or the nature of the
services, products, or devices [underlying the
transaction].”
72. Use of Scoring Data to Determine
Amount of Payments
• Does this trigger
duties under the
FCRA?
• Can this constitute
adverse action under
the FCRA?
• If it does, then what?
73. HITECH--The First Fines Have Hit!
• Cignet Health—4.3 million
• Failed to provide medical
records to 41 patients who
requested them
• MA General Hospital—1 million
• Employee left medical docs on
subway
74. A Sign of Things to Come?
• OCR Director Georgina Verdugo sent a stern
warning after the Mass General incident in
February, “We hope the healthcare industry
will take a close look at this agreement and
recognize that OCR is serious about HIPAA
enforcement. It is a covered entity’s
responsibility to protect its patients’ health
information.”
75. HITECH Act
• Business Associates now must comply with
HIPAA, and can be pursued by government for
HIPAA breaches.
• Business Associates directly liable for civil and
criminal penalties.
76. Notification of Breaches
CE’s and BA’s Must:
• Notify individuals of breach
• If more than 500 residents of a
state have had PHI breached,
prominent media outlets must be
notified
• Notification should be in writing,
or e-mail if that is individual’s
preferred method of contact
77. Content of Notification
• When breach happened
• When discovered
• What happened
• Type of PHI breached
• What individual can do to protect from
potential harm due to breach
• Corrective action and investigations to prevent
future braches and to mitigate losses
• Contact info for questions
78. Reports re Breaches
• At a minimum, annual reports to HHS of any
breaches where fewer than 500 breaches
involved
• Immediate report to HHS of any breach where
more than 500 breached involved
79. Civil Penalties
• “did not know/would not have known”
– $100 per violation; max 25k
• “reasonable cause”
– $1,000 per violation; max 100k
• “willful neglect” with corrective action
– $10,000 per violation; max 250k
• “willful neglect” no corrective action
– 50k per violation; max 1.5 million
80. Uninsured & Newly Unemployed
• High numbers of long-term unemployed
• Most will ultimately find work again
• These patients can be very collectible
accounts
• Special considerations
81. HIPAA
• Execution of
business associate
agreements
• Dealing with your
vendors
• Security
Requirements
• Subpoenas and
discovery requests
82. Subpoenas and Discovery Requests
• Under HIPAA, what is
the proper process for
responding to a
subpoena or a discovery
request?
83. 45 CFR §164.512(e)
• Prior to disclosing PHI in response to a
subpoena or discovery request, a covered
entity must receive satisfactory assurances
that either:
• (1) The requesting party has made reasonable
efforts to ensure that the subject of the PHI
has been given notice of the request; or,
84. 45 CFR §164.512(e) (continued)
• (2) The requesting party has made reasonable
efforts to secure a qualified protective order
meeting the requirements of 45 CFR
§164.512(e)(1)(v).
85. Satisfactory Assurances
• Written statement and accompanying
documentation demonstrating that:
• (1) Requesting party has made good faith
effort to provide written notice to the subject
of the PHI (or, if the subject’s location is
unknown, to mail a notice to the subject’s last
known address);
86. Satisfactory Assurances (continued)
• (2) The notice included sufficient information
about the litigation in which the PHI has been
requested to permit the subject of the PHI to
raise an objection to the Court;
• (3) The time to raise an objection has elapsed and
either, no objection was raised, or all filed
objections have been resolved, and the
disclosures being sought are consistent with such
resolution.
87. Qualified Protective Order
• Must prohibit the parties
from using or disclosing
the PHI for any purpose
other than the litigation
or proceeding;
• Must require the return
or destruction of the PHI
(including all copies) at
the end of the litigation
or proceeding.
88. Non-Conforming Subpoenas and
Discovery Requests
• How do you handle such requests which, but
for HIPAA, would be completely proper?
• 45 CFR §164.512(e)(1)(vi) allows the covered
entity to provide the required notice to the
subject of the PHI or to seek a qualified
protective order.
• Negotiations with opposing counsel.
• Motions to quash or for protective orders.
89. Fair Debt Collection Practices Act
• Enacted to govern the actions of “debt
collectors”
• Prescribes and prohibits certain collection
activities.
• Creditors attempting to collect their own
debts can sometimes fall within the FDCPA.
• Recent increase in the number of FDCPA
lawsuits against creditors.
90. Applicability of FDCPA
• In General, creditors are
exempt.
• §803(6)(A)--The term
debt collector does not
include “any officer or
employee of a creditor
while in the name of
the creditor, collecting
debts for such creditor.”
91. Situations Where FDCPA Does
Apply to Creditors
• §803(6)--When a creditor “in the process of
collecting his own debts, uses any name other
than his own which would indicate that a third
person is collecting or attempting to collect
such debts.”
• Any person violating §803(6) will be subject to
all of the provisions of the FDCPA, including
those relating to damages.
92. Situations Where FDCPA Does
Apply to Creditors
• §812(a)--When a creditor uses “any form
knowing that such form would be used to
create the false belief in a consumer that a
person other than the creditor of such
consumer is participating in a collection of or
in an attempt to collect a debt such consumer
allegedly owes such creditor, when in fact
such person is not so participating.”
93. Example of Violation of §812(a)--
Letter “Flat-Raters”
• FTC has cracked down upon practice of “flat-
rating” especially with attorneys.
• In 1993, FTC gave final approval to a consent
agreement with American Family Publishers
(“AFP”), settling charges that AFP violated the
FDCPA and the FTC Act by sending out letters
that falsely misrepresented that an attorney
was actively involved in the collection of the
debt.
94. Flat-Rating
• Under §812(a) of the FDCPA, it is unlawful to
design, compile, and furnish any form
knowing that such form would create the false
belief in a consumer that a person other than
the creditor is participating in the collection of
a debt owing the creditor, when in fact, that
person is not so participating.
95. Simply Stated…
• The FDCPA prohibits the practice of selling dunning
letters to creditors, to be sent by creditors to
debtors, without any meaningful participation by the
party selling the letters.
• Consumer attorneys point to such letters as evidence
that the third party was not “meaningfully involved”
in the collection process; that the letter is
misleading; and thus, that the creditor is liable under
the FDCPA.
96. So-Called “Pre-Collect” Services
• Is the pre-collect agency functioning as a
“debt collector”?
• §803(6)(A): A person is not considered a “debt
collector” if he is employed by the creditor
and collects debts in the creditor’s name.
–FTC Commentary--you can be considered
employed by a creditor client if under
contract with such creditor.
97. “Pre-Collect” Services
• Two alternatives:
–Services performed entirely in creditor’s
name under creditor’s control; or
–Services performed entirely in debt
collector’s name, in full compliance with
FDCPA.
98. Billing Services
• §803(6)(F)(iii) provides third party billers an
exemption from the FDCPA by stating that
“debt collector” does not include “any person
collecting or attempting to collect any debt
owed or due another to the extent that such
activity concerns a debt which was not in
default at the time it was obtained by such
person.”
99. Billing Services
• §803(6)(A), discussed earlier, also provides an
exemption that third party billers can use: A
person is not considered a “debt collector” if
he is employed by the creditor and collects
debts in the creditor’s name.
–FTC Commentary--you can be considered
employed by a creditor client if under
contract with such creditor.
100. Damages for Violations of §812(a)
• Any person who violates §812(a) is liable “to
the same extent and in the same manner as a
debt collector is liable under Section 813 for
failure to comply with a provision of this title
[the FDCPA].”
–Taylor v. Perrin, Landry, deLaunay & Durand,
103 F.3d 1232 (5th Cir. Jan 29, 1997).
101. Damages Under FDCPA--§813
• Actual damages;
• Statutory damages as the court may allow, not
to exceed $1,000.00; and,
–Note: if class action, $500,000.00 or 1% of
the debt collector’s net worth, whichever is
less;
• Costs including reasonable attorneys’ fees.
102. Who Can Enforce FDCPA?
• Consumers can file private law suits.
• FTC
• State counterparts to FDCPA can be
enforced by state Attorneys General
and in some instances District
Attorneys.
103. FTC Enforcement
• Can file suit under FDCPA or Federal
Trade Commission Act (the “FTC Act”).
• Section 5 of the FTC Act prohibits
“unfair or deceptive acts or practices.”
–Penalties include cease and desist
orders, injunctions, and civil
damages.
–Civil damages defined as $10,000.00
per violation.
104. Lipsett, FTC Informal Staff
Letter, Dec. 1, 1987
• “While creditors are exempt from the
coverage of the FDCPA, they may be
held liable for these activities under
Section 5 of the Federal Trade
Commission Act. In deciding whether to
impose such liability, the Commission
must look at several factors.
105. • Factors: the relationship of the parties;
the level of control of the creditor over
the debt collector or attorney; and the
extent of the creditor’s participation in or
knowledge of the practices.
• In addition, the Commission may
consider whether the creditor supported
the scheme or actually participated in
the practice at issue.
Lipsett, Continued
106. Lipsett, Continued
• Finally, if the creditor advises or
encourages the debt collector or
attorney to use particular collection
practices, it may be held liable for its
involvement if the practices are
improper.
107. Douglass, FTC Informal Staff
Letter, Nov. 26, 1993
• “If a creditor knowingly approves of
representations made by its debt
collectors that violate the Act or acts in
concert with or knowingly assists its
debt collectors in making these
representations, the creditor may have
engaged in unfair or deceptive acts or
practices in violation of Section 5 of the
Federal Trade Commission Act.”
108. Potential Pitfalls for Creditors
• Overshadowing
• Collecting interest and fees
• Flat-rating
• State collection practices acts
109. Potential Pitfalls for Creditors
• Concept of “overshadowing”.
–Contractually required collection
activity within the validation period.
–“Least sophisticated debtor” standard.
110. Collecting interest and fees
• Collection interest and fees.
–Can only collect such items if expressly
authorized by contract or permitted by law.
111. Interest and fees
–Issue: if the contract allows for the recovery
of collection costs, can a creditor turn a
$300.00 balance over to a collection agency
and ask the agency to send the consumer
collection letters asking for the payment of
$400.00?
112. Interest and fees, contd.
•Callison, FTC Informal Staff
Letter, Feb. 27, 1981--Imposing
a collection fee of 1/3 of the
amount due may be per se illegal,
especially if the amount of the debt
is substantial.
113. THANK YOU FOR THE OPPORTUNITY
TO MEET WITH YOU!
@AdamPlotkin
• http://www.linkedin.com/in/adamplotkin