Archive for month: March, 2015

Copiers are a hidden treasure for identity thieves

Categories: Articles

2015_03_03Have you ever thought about whose hands the information you copy can land?  Think of all the different types of documents that are copied – tax returns, medical records, financial information and more — and the personal information within these documents.

The reason is that these new age copiers contain hand drives, similar to computers, which are capable of storing a large volume of digital information.

Nearly all copiers made since 2002 for business use, and some for home use, contain a hard drive that can store every copy made, item printed or fax scanned. While the information might be encrypted, it’s not usually a challenge for hackers to access details, including Social Security and telephone numbers, bank accounts and credit-card numbers, according to digital experts.

Administrative service departments hold auctions for IT equipment where the equipment is sold to end users.  What could the motivation of these end users be beyond just acquiring the older equipment?

To remove the confidential information from the hard drive of the copier is the sole responsibility of the company that initially acquired the equipment.  To have other agencies or companies assume responsibility to sanitize the copier hard drive is a costly endeavor and not realistic.

Security companies across the company have called copiers, faxes and printers a gold mine for identify thieves.  Thieves sometimes rummage through garbage lots for discarded equipment to simply attain the hard drives for malicious use.

While security experts have been raising the alarm about copiers and similar devices, not many people are paying attention.  The idea has not echoed. It’s important to be proactive in this time of concern about identify theft.

It is highly recommended to destroy hard drives in old copiers and other machines or taking them to recycling companies.   Attaining a certificate of destruction is critical for proof that the necessary measures were taken to clear the owner from liability prior to returning or discarding the copier equipment.

Some state agencies have taken the necessary precautions to block thieves, but some companies have paid the price.   A New York medical organization had to pay the federal government a $1.2 million fine for leaving health information for 344,000 customers on the hard drives of leased copy machines.

States hold auctions for surplus electronics and other items to the public after they reach the end of their life for commercial use.  Other organizations, higher educational institutions and municipalities have first bid at the items before they are auctioned.  The selling organizations have used this vehicle as a revenue generator but have avoided conversation about the downside to their sales.

Warnings from the Federal Trade Commission about security issues with copiers and similar devices started taking place a few years ago.

“The hard drive in a digital copier stores data about the documents it copies, prints, scans, faxes or emails.   If you don’t take steps to protect that data, it can be stolen from the hard drive, either by remote access or by extracting the data once the drive has been removed,” stated in a federal bulletin at www.ftc.gov/tips-advice/business-center/copier-data-security-guide-businesses.

Some manufacturers include security options at additional cost to wipe out the information on copier hard drives.  Other suggestions are to take measures to include either encryption or overwriting, which covers existing data with random characters, making files difficult, if not impossible, to reconstruct.

Companies that lease or purchase copier equipment are the ones that are responsible for taking action at the end of the equipment life.  They cannot rely on sales reps in the copier industry as the industry has notoriously been known for massive turnover due to difficulty and individuals not being able to meet monthly quotas.

 

Rich Simons is Co-Founder and Managing Partner for EDGE Business Systems.  He helps improve efficiencies for medical practices providing analysis, customization and recommendations to create an efficient work environment for all document processes.  Feel free to connect at rsimons@edgeatl.com.    

Retirement savings options for small-business owners

Categories: Articles

2015_03_02Published on Tue Jul 15, 2014
By Alaina Tweddale

Owning a business comes with perks, such as being your own boss. But business owners have many priorities to manage, making it easy for saving and retirement planning to fall off the radar.

According to TD Ameritrade, there are 14.4 million self-employed workers in the U.S. and almost 70 percent of them aren’t saving regularly for retirement — including 28 percent who aren’t saving at all!

No business owner wants to find him or herself bumping up against retirement age without having a savings strategy set place. Here are some options that can help them avoid this.

Individual Retirement Accounts (IRA)

If you’re a self-employed business owner with no employees and limited funds, an IRA may be your first stop. An investor can save up to $5,500 per year ($6,500 if age 50 or older).

“The saver can invest in just about anything they want, including stocks, bonds, real estate, CDs, or a saving account, for example,” says Kevin Wenke, certified financial planner and author of “Comfort Investing.”

IRA investment options are almost unlimited, so you can shop for mutual funds with the lowest fees, find the best money market accounts or compare CD rates to find the options you’re happiest with. So long as your income falls within allowable limits ($181,000 if married or $114,000 if single), contributions are tax deductible and earnings are tax-deferred.

Roth IRA

The contribution and income limits are the same for both the traditional and Roth IRA. Though Roth contributions are not tax-deductible, the main advantage of the plan is that all earnings can be withdrawn tax-free, starting at age 59 1/2.

“The withdrawals from a Roth IRA will not count toward the tax a retired person will have to pay on their
Social Security income in retirement,” says Wenke.

Solo 401(k)

“The Solo 401k is one of the best kept secrets available to self-employed professionals,” says Scott Puritz, co-founder of retirement investment advisory firm Rebalance IRA. “It’s not talked about enough and it’s relatively new, but for some people this is the best solution that really evens the retirement playing field for everyone who doesn’t work for a major corporation.”

This plan allows business owners and their spouses to save 100 percent of income, tax deferred, up to the $17,500 limit (plus an additional $5,500 if over age 50). If your income is above that limit and you want to save even more, you can contribute an additional 25 percent of income, up to a maximum of $52,000 per year. These plans are easy to open and inexpensive to maintain.

Simplified Employee Pension IRA (SEP IRA)

A SEP IRA can be set up whether you have employees or not. According to Franklin J. Parker, managing director at CH Wealth Management, “The plan works well in professional practices where the owner makes significantly more than the employees, like a doctor, for example.”

The contribution limit is 25 percent of annual income for each employee, up to the $52,000 annual limit. The same contribution percentage must be set for each employee, including the owner, who makes all contributions (employees do not contribute on their own). With a SEP IRA, “the owner can put away considerable sums of money and provide a nice benefit for employees,” says Parker.

SIMPLE IRA

This plan is intended for the small business owner who has fewer than 100 employees. “It is ideally suited as a start-up retirement savings plan for small employers,” says Wenke.

Employees can contribute up to $12,000 annually ($14,500 if 50 or older), and the business owner is required to match employee contributions up to 3 percent of the employees’ annual salary. Although employee contributions could be expensive for a fledgling employer, the plan is easy and inexpensive to set up and maintain.

Defined Benefit (DB) Plans

“While a thing of the past for large corporations, defined benefit plans are still alive and well in the small business space and work well for small firms with highly paid owners,” says Parker.

A DB plan, otherwise known as a pension, can be expensive, but offering a pension can also increase employee retention, which can be a cost savings in itself. This is the most costly and complex of the plans (you’ll even need an actuary on board to calculate employee funding levels each year), but it can also offer the most sizable benefits.

No matter your company’s size or amount you want to put away, today is the day to get your retirement plan back on the radar if you’ve let it lapse. Any of the options above may be a great choice for doing so.

Provided by Joshua C. Harper, CFP®, CLU®, of WealthMD (877-Our-MDPlan or jharper@wealthmd.com)

How Medicare ‘Self-Referral’ Thrives on Loophole

Categories: Articles

A Florida Medical Group’s Urologists Send Tests to Lab, Share in Lab’s Revenue
By JOHN CARREYROU And JANET ADAMY
Oct. 22, 2014 10:30 p.m. ET

2015_03_01In a letter to a friend, the manager of a Florida urology practice worried in 2010 that her company would attract federal scrutiny for its frequent use of an expensive bladder-cancer test.

The manager’s concern involved a program at 21st Century Oncology Holdings Inc.—a national chain of cancer practices—that gives its urologists a financial incentive to order the test from a central in-house lab. A federal law since the 1990s has prohibited “self-referral,” in which doctors can profit from Medicare-reimbursed procedures they order. But 21st Century Oncology and many physician groups around the country have found ways to do it anyway, exploiting an exception to the law in ways its writers didn’t anticipate.

The manager attached an email from a 21st Century Oncology executive who touted an increase in the number of tests ordered through the central lab, and encouraged doctors in her office to direct business to the lab and share in the revenue. The surge in orders for the bladder-cancer test was so sharp, she wrote to her friend, that it would “surely bring the OIG to our door!”

The letter was prescient. The OIG, or Office of Inspector General at the U.S. Department of Health and Human Services, subpoenaed 21st Century Oncology in February, requesting records of patients it performed the bladder-cancer test on, the company disclosed in filings with the Securities and Exchange Commission this spring. The investigation focuses on whether the testing from 2007 to the present was medically necessary, according to the filings.

A 21st Century Oncology spokesman says the company is cooperating with the investigation and believes its actions “were proper and in accordance with applicable Medicare guidelines.”

The SEC filings didn’t mention self-referral. But ordering tests and treatments in-house is a pillar of 21st Century Oncology’s business model. By grouping several medical specialties under the same corporate roof, it captures revenues generated when one group of doctors refers patients to another. Its 95 urologists can get a cut of the revenues generated by the Fort Myers lab to which they refer tests.

The pricey bladder-cancer test, known as FISH, has been part of that program. Urologists at 21st Century Oncology ordered it frequently, says Richard D. Fernandez, its senior
pathologist from 2009 until late 2010. “There was in the background, I suppose, a financial component” to the urologists’ propensity to order the test, he says.

Newly released Medicare billing records, made public following a legal effort by The Wall Street Journal, show 21st Century Oncology is an outlier in billing for a computer-assisted version of the FISH test. Its two current pathologists in 2012 each billed Medicare more for that version of the test than any other pathologist or lab in the country, the data show.

The company says its urologists order the test through its two pathologists for valid medical reasons, not financial ones. Catching bladder cancer early keeps patients alive by turning the disease “into a chronic illness” instead of a death sentence, says Constantine Mantz, the company’s chief medical officer.

Self-referral has become common practice among many U.S. physician groups, which refer anything from lab services to MRIs to entities from which they benefit financially.

That wasn’t the intention of Congress two decades ago, when it passed the so-called Stark Law banning self-referral when the patient is covered by Medicare or another government plan. The law, named after former Rep. Pete Stark (D., Calif.), includes an “in-office ancillary services” exception—intended for simple, routine procedures such as in-office blood tests that would let doctors make patient care more efficient.

But as technology advanced, doctors argued the exception applied to newer services they could administer in an office, such as sophisticated diagnostic tests and radiation therapy. The government didn’t challenge this interpretation, leading many physician practices to buy medical equipment they could profit from.

Mr. Stark, who is 82 years old and retired, says the exception has been so expertly exploited that he probably wouldn’t vote for the law today unless it were changed. “When I began to see that evolve,” he says, he asked himself, “Why did we do the law in the first place?”

Part of a series examining how payments are made in the roughly $600 billion Medicare system.

Regulators have gone after some hospitals. The Justice Department in March reached a settlement with Halifax Hospital Medical Center and Halifax Staffing Inc. of Daytona Beach, Fla., in which the hospital system agreed to pay $85 million, without admitting wrongdoing, to resolve allegations it violated the Stark Law by providing an incentive bonus to a number of oncologists that improperly included the value of prescription drugs and tests the oncologists ordered. Halifax declines to comment.

But regulators have largely not challenged physician groups that can invoke the in-office exception.

Cancer specialist 21st Century Oncology owns a network of cancer centers in 16 states that specialize in radiation therapy. It had $646 million in U.S. revenue in 2013, according to a May financial filing—55% of that from Medicare.

Doctors at 21st Century Oncology have a number of ways to benefit financially from self-referrals.

Launched by cancer doctors in 1983, the company acquired urology and radiation-oncology practices around the country. It says patients benefit from its “integrated cancer care” model, in which company urologists often refer patients with prostate cancer to their oncologist colleagues for radiation therapy. That model allows the urologists to share in the revenue generated by the radiation treatments. Medicare reimbursements for radiation therapy can reach $30,000 a case, according to Astro, the medical society for radiation oncologists.

The company entered pathology in 2009 by starting its Fort Myers lab. It encouraged its urologists to order tests from the lab, promising them a cut of testing revenues, according to the email from the 21st Century Oncology executive, Michael Tompkins, to the urology-practice manager.

One test, in particular, began to generate big revenues: a bladder-cancer test known as fluorescent in situ hybridization, or FISH.

At the time, Medicare paid from $700 to just under $1,000 for the FISH test. For an older test used for the same purpose, Medicare paid up to $84 in the 21st Century Oncology lab’s region.

There is debate over the FISH test’s value. Ashish Kamat, a urologic oncologist at MD Anderson Cancer Center in Houston, says it is valuable for detecting tumors in patients with aggressive bladder cancer. But a 2010 study he conducted with colleagues found the FISH test had a high rate of false positives.

Urologists at 21st Century Oncology quickly increased orders to the new lab to 942 FISH tests in October 2009 from 202 tests in May 2009, according to a table and chart contained in Mr. Tompkins ’ email.

“If you are interested in revisiting the financials we would love to have your group aboard,” he wrote to the practice manager. “The return to the physicians is about 50% of the total revenue that is distributed out in the pools that urologist belong.”

The company spokesman, addressing the increased 2009 FISH testing, says a lab’s volume typically rises rapidly in the months after it opens, as it ramps up operations.

Mr. Tompkins declines to comment about his email. The spokesman says Mr. Tompkins’s phrasing incorrectly implied that urologists’ pay is tied to their individual test-referral volume. Rather, the spokesman says, urologists are paid bonuses linked to the lab’s overall test revenue, which he says is permitted by the Stark Law exception.

The 21st Century Oncology lab collected $7.8 million from Medicare in 2010 through the identification number of Dr. Fernandez, its senior pathologist at the time. Of that, nearly $5 million was for the FISH test, the company says.

Dr. Fernandez says he merely executed his urologist colleagues’ frequent orders for the test. He says the high reimbursements may have driven that heavy order flow.

“If you’re going to be the beneficiary of testing that you order, and you’re going to order a test for $50 and get an answer…or maybe somewhat justifiably order a similar test for $1,000,” he says, “it might be reasonable to think that some individuals would be swayed by the test that is more highly compensated.”

The company, in response, says its urologists order tests for medical reasons, not financial ones.

In 2011, Medicare cut the reimbursement to a maximum of about $430 for the computer-assisted version of the FISH test 21st Century Oncology uses. The 2012 Medicare data released in April after the Journal’s legal effort show it continued to use the test extensively.

Brian Babbin and George Kalemeris, the pathologists who now head its Fort Myers lab, performed the computer-assisted version of the test 12,180 times in 2012. Through the two pathologists’ identification numbers, 21st Century Oncology collected $4.13 million—21% of what Medicare paid out nationwide to 379 pathologists and labs for that version of  the test in 2012.

The spokesman says the pathologists’ billings reflect the lab’s total Medicare billings for all the tests ordered by 21st Century Oncology doctors. Dr. Babbin and Dr. Kalemeris decline to comment.

A report the OIG released this summer cited questionable Medicare billings by laboratories, including 21st Century Oncology’s. The report didn’t discuss the FISH test or self-referral, but it showed the lab stood out among its peers.

The agency analyzed 94,609 labs and found 1,025 of them exceeded its thresholds for five or more measures of questionable billing. It highlighted, without naming them, six of those labs.

It cited a nonindependent laboratory in Florida for having an average Medicare reimbursement per ordering physician of $107,700 in 2010—24 times the average for all nonindependent labs. The lab’s average reimbursement per Medicare patient was $1,193—16 times the average for such labs.

The lab is 21st Century Oncology’s, the company confirms.

The OIG found the company met three other criteria for questionable Medicare billing: In 2010, it had a high percentage of claims for beneficiaries who lived more than 150 miles from the ordering physician, a high percentage of duplicate lab tests and a high percentage of claims with a “compromised” patient-identification number.

Dr. Mantz, 21st Century Oncology’s chief medical officer, discussing the OIG report, says its lab’s billings are unusual because the company specializes in treating more elderly patients with cancer than average. “We do serve a very different population,” he says. The company spokesman says it counts snowbirds who winter in Florida among its patients, which might explain the rate of beneficiaries who live far from their ordering physicians.

The OIG is conducting its civil investigation with the U.S. attorney’s office for the middle district of Florida, 21st Century Oncology said in its spring SEC filing. In an August SEC filing it said it recorded a liability of about $5 million on its balance sheet to account for how much it may have to pay should it decide not to litigate. It estimated its maximum financial exposure at $10 million.

“Our recording of a liability related to this matter is not an admission of guilt,” it said. “We believe we have a meritorious position.”

The College of American Pathologists and some other medical societies advocate narrowing the scope of the Stark Law’s in-office ancillary-services exception. In its last two budgets, the White House recommended doing so, estimating it would save Medicare $6 billion over 10 years by eliminating medical overutilization the exception can foster.

When the White House made the proposal last year, 21st Century Oncology and seven other radiation-oncology groups sent the Senate leadership a letter opposing it. The company’s political-action committee has spent nearly $440,000 over the past three election cycles. The family of Daniel Dosoretz, its co-founder and chairman, has made about $200,000 in political donations since 2009.

The 21st Century Oncology spokesman says its PAC’s “efforts are designed to protect and promote the patients that we serve.” Dr. Dosoretz declines to comment. Mr. Stark says when he hears his namesake law mentioned when visiting a doctor, “I just look the other way and pretend that I had a lot of cousins.”

—Tom McGinty and Christopher S. Stewart contributed to this article.

Write to John Carreyrou at john.carreyrou@wsj.com and Janet Adamy atjanet.adamy@wsj.com

Carl C. Schuessler, Jr., DHP, DIA, GBDS
BenefitStrategies, LLC.
2776 Ridge Valley Rd. NW
Bldg. 100, Suite 150
Atlanta, GA 30327-1850
Work: (404) 941-5519
Mobile: (404) 277-7852
efax: (928) 833-2265
Email: carl@benefitstrategiesllc.com

Manager of the Month

Categories: Practice Manager of the Month

201503_AnneCampbellThe HST team is about “professionals dedicated to the success of medical practices.” Each month, we recognize a practice manager who shares our passion and success in doing this, and provide you her or his advice.

 

Anne Campbell
My OBGYN

Anne Campbell is entering her 12th year as Practice Manager at My OBGYN, PC which has offices in Riverdale and McDonough. She brings to her job as a practice manager elements from her teaching background. Drawing on that prior teaching experience she enjoys helping people learn whether it is a staff member learning how to do his or her job or patients who are learning what they need to know as part of the process of having a baby. Working in sports taught her the importance of bringing everyone in the practice together to work as a team. As a part of that experience in team sports she enjoys the challenge of not only assembling a team but maintaining her practice staff team, making sure that it   works together.

Anne believes that providing the staff with constant opportunities to learn is an important part of any practice manager’s job description. She believes that the staff is constantly looking to the practice manager for guidance and it is critical that the practice manager see those needs for direction and for the manager to provide that direction. She believes that another important attribute of a practice manager is patience. When giving direction and teaching your staff it is important to remember that everyone learns differently and at different rates. A practice manager must understand that fact and use that understanding to get their direction and training across to their staff. If the staff is given good direction by a manager who also practices compassion it goes a long way towards having a staff that works well together and toward staff retention. Staff retention according to Anne is critically important for the sake of the practice but it is also important for patients to see the same people year after year. A patient visit is stressful enough on its own but if patients see people they know, staff who know them, it makes the visit a little less stressful.

Anne graduated from The University of Tennessee where she worked as a student trainer and later as a graduate assistant trainer in the women’s basketball program. As a part of her training she received a certification as an athletic trainer which involves a heavy emphasis on physical therapy. After  leaving Tennessee she went to work as the director of the business office for a large multi-specialty practice in Greenville, South Carolina which had 27 doctors and 5 locations. Later she came back to Atlanta and worked for East Cobb Pediatrics as their Practice Manager. Prior to coming to My OBGYN she was director of rehabilitation for a pain management practice where she again drew on her college experience as an athletic trainer.

Anne feels that she has taken something from every place she has worked. Her early inspiration and direction came from her mother and her mother’s two sisters who were all nurses. Through her exposure to them she had an early exposure to healthcare.  While she can’t think of any specific pieces of advice that came out of seeing her mother and aunts in healthcare she knows that exposure was one of the things which guided her path. Also she worked with the legendary Pat Summit,  head coach of Tennessee’s women’s basketball program. In Anne’s words it would be impossible not to take away from exposure to such an incredible role model tidbits of advice and life lessons which are invaluable. Anne says that Pat Summit’s drive was an inspiration to everyone who came into contact with her as was her penchant for treating everyone fairly. Anne has incorporated that ideal of “fair treatment” into all her relationships at My OBGYN.

When not at the practice Anne enjoys gardening, particularly vegetable gardening and can be found this time of year readying her garden for the next planting season. She also likes woodworking. She has a shop and has done ‘”fun projects” such as building the raised beds for her gardening hobby. Her other hobby is making homemade bread. She makes homemade sour dough bread and is experimenting with other bread recipes.

One of the partners in her practice Dr. Letitia Royster described Anne’s importance by saying “Anne has successfully taken us through several very difficult transitions. She continues to be diligent with keeping us up to date as well as placing us in the best or most advantageous positions in this environment of changing healthcare. That allows us to provide our patients with the outstanding care and service.”

Congratulations to Anne for what she brings to her practice and for her selection as Healthcare Services Team’s Practice Manager of the Month.

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