|PHYSICIAN AND MEDICAL PRACTICE HIPAA PRIVACY COMPLIANCE PROTOCOL
on our Fraud and Abuse Compliance Protocol, this 60 pp document breaks down HIPAA Privacy
Compliance into understandable steps. With a Glossary, List of Resources, and Key
Questions for each of the 8 Steps to Compliance, a medical practice can come to grips with
creating a customized, manageable, realistic response to the mandate to have a compliance
program in place. Compliance is not a one size fits all proposition, nor is this document
a book of forms, although the governments Business Associate model contract is
included. This document helps practices develop their own program without paying
exorbitant fees to external consultants who dont know what you do as well as you
know it. Failure to conform to the regulations can lead to fines as well as criminal
penalties. This document is available for $75 billed to clients, and $125 prepaid to
PHYSICIAN AND MEDICAL PRACTICE FRAUD AND ABUSE COMPLIANCE PROTOCOL
We do not write compliance plans since we believe that the best compliance plan is one
in which the client is fully invested in terms of time and intellectual commitment. We
have, however, developed a compliance protocol entitled, "Physician and Medical
Practice Compliance Protocol." As with much in compliance, this 42 page document will
be dynamic and updated over time. It is available for $75 for clients and $125 for
A GUIDE TO KEY LEGAL ISSUES IN MANAGED CARE QUALITY
Alice Gosfields enlightening book, A Guide to Key Legal Issues in Managed
Care Quality is now available directly from Alice G. Gosfield and Associates, P.C.
Originally sold for $145, we can make this 253 page book, originally published by Faulkner
and Gray available to you for $95 plus $5 shipping and handling ($100 total prepaid).
For a review, click here.
This book is for non-lawyers. Written in a breezy, informative style, it examines the
single most challenging problem in the new era -- quality in managed care. The impact of
the law on this effort is central to the critical insights and elucidations offered. In
nine chapters, this book addresses fundamental legal principles which pertain to
relationships in managed care, caselaw on liability, state regulation of managed care
quality, accreditation, typical provider contract provisions which affect quality, federal
controls on managed care quality, and issues in performance measurement and data
dissemination. Finally, the book outlines the basic questions all of the health care
players must address in the day-to-day world as well as in public policy as we grapple
with this most vital problem for the American people.
The table of contents includes the following:
Chapter 1 The Quality of Health Care: Is It Strained?
A discussion of basic principles of quality and value purchasing juxtaposed
against managed care techniques. The entities involved in providing managed care and new
theories of managed care quality are presented. How the law influences quality is
Chapter 2 Whos Responsible?: Liability in Managed Care Caselaw
Potentially the most contentious issue in health care today, this chapter looks
at the caselaw on ERISA through 1995 which has led to today's patients' rights debate.
Anybody who cares about patients' rights needs to understand the matters here.
Chapter 3 What Big Brother is Watching: Federal Controls on Managed Care
(By Robert L. Roth)
Bob Roth, a veteran health law practitioner in Washington, D.C. wrote this
chapter dealing with the role of the federal government generally and the quality control
systems which were in place under federal law prior to Medicare+Choice.
Chapter 4 Carrots and Sticks: The Federal Fraud and Abuse Laws and Quality
It is not well understood that there has long been a concern for quality under
federal law. This chapter looks at new theories of quality and false claims, and the
governments authority over exclusions, intermediate sanctions and civil money
penalties as they relate to managed care. Anti-kickback laws and the Stark statute are
also addressed as they were in effect as of 1995.
Chapter 5 The Wheat From the Chaff: Accreditation and Regulation
Accreditation entities have multiplied and the way they approach accreditation
in managed care varies. This chapter looks at the link between accreditation and
regulation and the activities of multiple accrediting bodies including NCQA, JCAHO, URAC
and the now defunct TMQC (The Medical Quality Commission).
Chapter 6 The Little Red Hen Syndrome: States and "Anti-Managed
(By Robert L. Roth)
Bob Roth looks at the ERISA laws and how states launched into solving the problem
of managed care reform before the federal government ever picked up the issue. The
phenomena he identified continued throughout the country and remain in place.
Chapter 7 Whats the Deal?: Contractual Terms Aimed at Quality
Control and Risk Management
Managed care contracts with physicians and providers include many provisions
that go well beyond the payment system or compensation rates. This chapter elucidates
those provisions in managed care contracts which are intended to motivate provider
behavior with regard to quality.
Chapter 8 Numbers, Numbers, Whos Got the Numbers?: Law and the
Quantification of Quality
The advent of performance measurement and report cards found its basic
iterations in the managed care world. The role of clinical practice guidelines and the
implications of HEDIS date are considered along with beginning issues associated with data
protection and confidentiality.
Chapter 9 Back to the Future: Millennial Speculations
This chapter draws together the themes in the book and speculates on the
implications of developing trends in late 1995. That which was predicted has come true and
one review compared this chapter with the prophecies of Nostradamus!