New Jersey - Volume VIII, Number 4 - April, 1999
New Jersey - Volume VIII, Number 4 - April, 1999
PROMPT PAYMENT LEGISLATION REMAINS UNSIGNED
Prompt payment legislation (see Statlaw, Vol. 8, No. 3), continues to await final approval by Governor Whitman. Senate Bill 323 sets a payment schedule of 40 days for paper claims and 30 days for electronic claims. That bill was conditionally vetoed by the Governor, and then was passed by the upper house and awaits final passage by the Assembly. The Governor has until May 3rd to sign Assembly Bill 2121 which allows the State to take enforcement action in the event of an unreasonably large number of rejected, denied or unpaid claims by a payer and requires health insurers to provide physicians and hospitals with a monthly list of paper claims received by the insurer. Passage of this legislation, with the "monthly recap" provision intact, remains a priority for the Medical Society of New Jersey. Contact the Governor’s office by calling 609-292-6000 or faxing 609-292-3454, to voice your support.
On other legislative items, the Governor has signed a bill establishing the parameters for granting immunity from civil liability for the use of automatic external defibrillators (AEDs) by trained personnel. The Senate and Assembly also have passed legislation requiring insurance coverage for "biologically based" mental illness on the same basis as coverage for other physical illnesses. The Governor’s approval is uncertain, however, because of increased insurance mandates. As a result, the bill may be referred to a task force established by the Governor to study health insurance mandates.
OIG ISSUES SPECIAL FRAUD ALERT RE PHYSICIAN LIABILITY FOR CERTIFICATIONS OF MEDICAL NECESSITY FOR DME/HOME HEALTH
The Office of Inspector General of the Department of Health and Human Services ("OIG") has discovered, through OIG audits, that physicians sometimes fail to discharge their responsibility to assess their patients’ conditions and need for home health care. Similarly, the OIG has found numerous examples of physicians who have ordered durable medical equipment ("DME") or signed certificates of medical necessity for DME without reviewing the medical necessity for the item or even knowing the patient. Unscrupulous suppliers and providers may steer physicians into signing or authorizing improper certifications of medical necessity. The OIG points out that a physician is not personally liable for erroneous claims due to mistakes, inadvertence or simple negligence (if such innocence can be proved). However, knowingly signing a false or misleading certification or signing with reckless disregard for the truth can lead to serious criminal, civil, and administrative penalties. Examples of potential violations include: signing a certification as a "courtesy" to a patient, service provider or DME supplier when the physician has not first made a determination of medical necessity; knowingly or recklessly signing a false or misleading certification that causes a false claim to be submitted to a federal health care program; or receiving any financial benefit for signing the certification (including free or reduced rent, patient referrals, supplies, equipment or free labor). Even if a physician does not receive any financial or other benefit from providers or suppliers, the physician may be liable for making false or misleading certifications.