Medical Billing and Coding Careers Increase Your Career Potential Become a well-rounded resource in the healthcare community by maximizing your career potential as a medical Billing and Coding specialist. Be prepared to be a vital part of any hospital, clinic and healthcare facility nationwide - medical Billing and Coding careers open the door to many career paths!A medical Coding and Billing specialist is responsible for accurately recording and processing data about patients, such as treatment records, insurance information, bills and payments. As a biller and coder, you will code a patient's treatment and diagnosis, and request payments from the insurance company or directly from the individual - you'll play an essential part in the billing cycle from beginning to end!
06:46
Annapoorna
Posting Date: Fri, 24 May 2019 09:57:58 GMT
City:Ansbach
State: BY
Country: Germany
0620 Practical Nurse. Basic Requirement for a Practical Nurse:. A current license to practice as a practical/vocational nurse in a State or territory of the...
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06:46
Annapoorna
Posting Date: Thu, 16 May 2019 12:49:51 GMT
City:Düsseldorf
State: NW
Country: Germany
Sie verfügen über Zusatzqualifikation als Study Nurse sowie praktische Erfahrungen in der Betreuung von Patienten im Klinik- oder Praxisbereich....
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06:34
Annapoorna
Posting Date: Thu, 16 May 2019 05:37:03 GMT
City:
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Country: Germany
Eine Weiterbildung zur Stroke Nurse wäre wünschenswert. Werden auch Sie Teil der AMEOS Gruppe und leben mit uns die Mission:....
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06:33
Annapoorna
Posting Date: Thu, 16 May 2019 16:31:18 GMT
City:Essen
State: NW
Country: Germany
Sie bringen mit: Weiterbildung zur Study Nurse Erfahrung in der Durchführung von klinischen Studien Erfahrung mit Qualitätsmanagement...
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06:33
Annapoorna
Posting Date: Tue, 21 May 2019 20:37:21 GMT
City:Traunstein
State: BY
Country: Germany
Studienassistent / Study Nurse (w/m/d). Die Zusatzqualifikation als Studienassistent/Study Nurse (m/w/d) ist von Vorteil, jedoch keine Voraussetzung....
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06:33
Annapoorna
Posting Date: Fri, 24 May 2019 06:49:13 GMT
City:Berlin
State: BE
Country: Germany
Zusatzqualifikation zum/r Studienassistent*in / Study Nurse*. Die Charité – Universitätsmedizin Berlin ist eine gemeinsame Einrichtung der Freien Universität...
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06:33
Annapoorna
Posting Date: Wed, 22 May 2019 07:43:42 GMT
City:Stuttgart
State: BW
Country: Germany
Unsere Arbeit ist unglaublich vielfältig und geht von der i.v. Punktion in der häuslichen Umgebung, der Anleitung der Eltern zur Punktion ihres Kindes bis hin...
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06:33
Annapoorna
Posting Date: Thu, 16 May 2019 13:59:30 GMT
City:Düsseldorf
State: NW
Country: Germany
Sie verfügen über Zusatzqualifikation als Study Nurse sowie praktische Erfahrungen in der Betreuung von Patienten im Klinik- oder Praxisbereich....
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06:32
Annapoorna
Posting Date: Thu, 16 May 2019 12:05:42 GMT
City:Braunschweig
State: NI
Country: Germany
Alternativ Ausbildung zur Study Nurse (w/m/d) oder Krankenschwester/-pfleger. Im Studienzentrum des Helmholtz-Zentrums für Infektionsforschung GmbH ist im...
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06:32
Annapoorna
Posting Date: Wed, 29 May 2019 10:32:38 GMT
City:Köln
State: NW
Country: Germany
Die qualifizierte Study Nurse unterstützt den Prüfarzt in der fachgerechten und qualitativ hochwertigen Durchführung klinischer Studien am Menschen....
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06:32
Annapoorna
Posting Date: Mon, 20 May 2019 10:29:13 GMT
City:
State: NI
Country: Germany
Medizinisch-technischen Bereich mit Zusatzausbildung zur Study Nurse (m/w/d) und ggf. Das Städtische Klinikum Braunschweig ist das Krankenhaus der...
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06:32
Annapoorna
Posting Date: Tue, 21 May 2019 08:51:14 GMT
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Country: Germany
Studienassistent / Study Nurse (w/m/d). Qualifikation als Studienassistent/Study Nurse (m/w/d) ist von. /e....
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05:17
Annapoorna
Posting Date: Thu, 23 May 2019 13:20:45 GMT
City:Erlangen
State: BY
Country: Germany
The School nurse works with teachers to help them understand the health care needs of individual children....
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05:17
Annapoorna
Posting Date: Thu, 23 May 2019 12:54:13 GMT
City:München
State: BY
Country: Germany
muenchen-klinik.de/stellenangebote Mit den fünf Standorten Bogenhausen, Harlaching, Neuperlach, Schwabing, Thalkirchner Straße, unserer Bildungseinrichtung...
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05:17
Annapoorna
Posting Date: Mon, 27 May 2019 03:26:32 GMT
City:Hamburg
State: HH
Country: Germany
Arbeiten am Puls der Zeit. In einem komprimierten Kosmos, der sich ständig wandelt. Einem Umfeld, in dem Sie selbst viel bewirken können. Weil es Ihnen...
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05:16
Annapoorna
Posting Date: Mon, 20 May 2019 14:31:10 GMT
City:München
State: BY
Country: Germany
Study Nurse (m/w/d) in Vollzeit; Das Klinikum der Universität München ist eines der größten und leistungsfähigsten....
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05:16
Annapoorna
Posting Date: Tue, 21 May 2019 14:31:11 GMT
City:München
State: BY
Country: Germany
Study Nurse (m/w/d). Das Klinikum der Universität München ist eines der größten und leistungsfähigsten....
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05:04
Annapoorna
Posting Date: Wed, 22 May 2019 07:43:41 GMT
City:Köln
State: NW
Country: Germany
Unsere Arbeit ist unglaublich vielfältig und geht von der i.v. Punktion in der häuslichen Umgebung, der Anleitung der Eltern zur Punktion ihres Kindes bis hin...
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05:03
Annapoorna
Posting Date: Mon, 27 May 2019 12:48:14 GMT
City:Berlin
State: BE
Country: Germany
Zusatzqualifikation zum/r Studienassistent*in / Study Nurse erwünscht. Die Charité – Universitätsmedizin Berlin ist eine gemeinsame Einrichtung der Freien...
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05:03
Annapoorna
Posting Date: Mon, 20 May 2019 14:19:43 GMT
City:Regensburg
State: BY
Country: Germany
STUDIENASSISTENTEN/STUDIENKOORDINATOREN/ STUDY NURSE (m/w/d) in Vollzeit (38,5 Stunden/Woche), zunächst befristet für ein Jahr mit der Möglichkeit der...
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05:03
Annapoorna
Posting Date: Tue, 21 May 2019 20:00:02 GMT
City:
State: TH
Country: Germany
Mentor less experienced Nurse Advisors. Registered Nurse with 1 year post registration experience; Join us on our exciting journey!...
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05:03
Annapoorna
Posting Date: Fri, 17 May 2019 01:32:01 GMT
City:Heidelberg
State: BW
Country: Germany
Teilzeit 50% - JobID: P0035V096 ab 01.06.2019 für das Zentrum für Innere Medizin, Klinik für Kardiologie, Angiologie und Pneumologie (Innere Medizin III,...
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05:03
Annapoorna
Posting Date: Sun, 19 May 2019 13:50:00 GMT
City:Hamburg
State: HH
Country: Germany
Ausbildung zum examinierten Gesundheits- und Krankenpfleger, Arzthelfer oder Study Nurse (m/w). Indivumed unterhält die weltweit größte Tumorgewebe- und...
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05:02
Annapoorna
Posting Date: Mon, 20 May 2019 09:42:41 GMT
City:Freiburg
State: BW
Country: Germany
Ausbildung als Study Nurse (m/w/d), alternativ in der Gesundheits- und Krankenpflege oder in einem verwandten Beruf (mit medizinischem Hintergrund)....
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05:02
Annapoorna
Posting Date: Wed, 22 May 2019 18:24:15 GMT
City:Darmstadt
State: HE
Country: Germany
A licensed health-care professional (i.e., registered nurse); Premier Research helps highly innovative bio-pharmaceutical and medical device companies transform...
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05:02
Annapoorna
Posting Date: Fri, 24 May 2019 09:57:58 GMT
City:Ansbach
State: BY
Country: Germany
0620 Practical Nurse. Basic Requirement for a Practical Nurse:. A current license to practice as a practical/vocational nurse in a State or territory of the...
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05:02
Annapoorna
Posting Date: Thu, 16 May 2019 12:49:51 GMT
City:Düsseldorf
State: NW
Country: Germany
Sie verfügen über Zusatzqualifikation als Study Nurse sowie praktische Erfahrungen in der Betreuung von Patienten im Klinik- oder Praxisbereich....
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04:48
Annapoorna
Posting Date: Thu, 16 May 2019 05:37:03 GMT
City:
State:
Country: Germany
Eine Weiterbildung zur Stroke Nurse wäre wünschenswert. Werden auch Sie Teil der AMEOS Gruppe und leben mit uns die Mission:....
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04:48
Annapoorna
Posting Date: Thu, 16 May 2019 16:31:18 GMT
City:Essen
State: NW
Country: Germany
Sie bringen mit: Weiterbildung zur Study Nurse Erfahrung in der Durchführung von klinischen Studien Erfahrung mit Qualitätsmanagement...
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04:48
Annapoorna
Posting Date: Tue, 21 May 2019 20:37:21 GMT
City:Traunstein
State: BY
Country: Germany
Studienassistent / Study Nurse (w/m/d). Die Zusatzqualifikation als Studienassistent/Study Nurse (m/w/d) ist von Vorteil, jedoch keine Voraussetzung....
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04:48
Annapoorna
Posting Date: Fri, 24 May 2019 06:49:13 GMT
City:Berlin
State: BE
Country: Germany
Zusatzqualifikation zum/r Studienassistent*in / Study Nurse*. Die Charité – Universitätsmedizin Berlin ist eine gemeinsame Einrichtung der Freien Universität...
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04:47
Annapoorna
Posting Date: Wed, 22 May 2019 07:43:42 GMT
City:Stuttgart
State: BW
Country: Germany
Unsere Arbeit ist unglaublich vielfältig und geht von der i.v. Punktion in der häuslichen Umgebung, der Anleitung der Eltern zur Punktion ihres Kindes bis hin...
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04:47
Annapoorna
Posting Date: Thu, 16 May 2019 13:59:30 GMT
City:Düsseldorf
State: NW
Country: Germany
Sie verfügen über Zusatzqualifikation als Study Nurse sowie praktische Erfahrungen in der Betreuung von Patienten im Klinik- oder Praxisbereich....
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04:47
Annapoorna
Posting Date: Thu, 16 May 2019 12:05:42 GMT
City:Braunschweig
State: NI
Country: Germany
Alternativ Ausbildung zur Study Nurse (w/m/d) oder Krankenschwester/-pfleger. Im Studienzentrum des Helmholtz-Zentrums für Infektionsforschung GmbH ist im...
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04:47
Annapoorna
Posting Date: Wed, 29 May 2019 10:32:38 GMT
City:Köln
State: NW
Country: Germany
Die qualifizierte Study Nurse unterstützt den Prüfarzt in der fachgerechten und qualitativ hochwertigen Durchführung klinischer Studien am Menschen....
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04:47
Annapoorna
Posting Date: Mon, 20 May 2019 10:29:13 GMT
City:
State: NI
Country: Germany
Medizinisch-technischen Bereich mit Zusatzausbildung zur Study Nurse (m/w/d) und ggf. Das Städtische Klinikum Braunschweig ist das Krankenhaus der...
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04:46
Annapoorna
Posting Date: Tue, 21 May 2019 08:51:14 GMT
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Studienassistent / Study Nurse (w/m/d). Qualifikation als Studienassistent/Study Nurse (m/w/d) ist von. /e....
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03:07
Annapoorna
For a hospital that had once labored to break even, Wheeling Hospital displayed abnormally deep pockets when recruiting doctors.
To lure Dr. Adam Tune, an anesthesiologist from nearby Pittsburgh who specialized in pain management, the Catholic hospital built a clinic for him to run on its campus in Wheeling, W.Va. It paid Tune as much as $1.2 million a year — well above the salaries of 90% of pain management physicians across the nation, the federal government charged in a lawsuit filed this spring.
In addition, Wheeling paid an obstetrician-gynecologist a salary as high as $1.3 million a year, so much that her department bled money, according to a related lawsuit by a whistleblowing executive. The hospital paid a cardiothoracic surgeon $770,000 and let him take 12 weeks off each year even though his cardiac team also routinely ran in the red, that lawsuit said.
Despite the losses from these stratospheric salaries and perks, the recruitment efforts had a golden lining for Wheeling, the government asserts. Specialists in fields like labor and delivery, pain management and cardiology reliably referred patients for tests, procedures and other services Wheeling offered, earning the hospital millions of dollars, the lawsuit said.
The problem, according to the government, is that the efforts run counter to federal self-referral bans and anti-kickback laws that are designed to prevent financial considerations from warping physicians’ clinical decisions. The Stark law prohibits a physician from referring patients for services in which the doctor has a financial interest. The federal anti-kickback statute bars hospitals from paying doctors for referrals. Together, these rules are intended to remove financial incentives that can lead doctors to order up extraneous tests and treatments that increase costs to Medicare and other insurers and expose patients to unnecessary risks.
Wheeling Hospital is contesting the lawsuits. It said in a countersuit against the whistleblower that its generous salaries were not kickbacks but the only way it could provide specialized care to local residents who otherwise would have to travel to other cities for services such as labor and delivery that are best provided near home.
The hospital and its specialists declined requests for interviews. In a statement, Gregg Warren, a hospital spokesman, wrote, “We are confident that, if this case goes to a trial, there will be no evidence of wrongdoing — only proof that Wheeling Hospital offers the Northern Panhandle Community access to superior care, world class physicians and services.”
Elsewhere, whistleblowers and investigators have alleged that other hospitals, in their quests to fill beds and expand, disguise these arrangements by overpaying doctors or offering other financial incentives such as free office space. More brazenly, others set doctor salaries based on the business they generate, federal lawsuits have asserted.
“If we’re going to solve the health care pricing problem, these kinds of practices are going to have to go away,” said Dr. Vikas Saini, president of the Lown Institute, a Massachusetts nonprofit that advocates for affordable care.
‘It’s Almost A Game’
Hospitals live and die by physician referrals. Doctors generate business each time they order a hospital procedure or test, decide that a patient needs to be admitted overnight or send patients to see a specialist at the hospital. An internal medicine doctor generates $2.7 million in average revenues — 10 times his salary — for the hospital with which he is affiliated, while an average cardiovascular surgeon generates $3.7 million in hospital revenues, nearly nine times her salary, according to a survey released this year by Merritt Hawkins, a physician recruiting firm.
Last August, William Beaumont Hospital, part of Michigan’s largest health system and located outside Detroit, paid $85 million to settle government allegations that it gave physicians free or discounted offices and subsidized the cost of assistants in exchange for patient referrals.
A month later in Montana, Kalispell Regional Healthcare System paid $24 million to resolve a lawsuit alleging that it overcompensated 63 specialists in exchange for referrals, paying some as full-time employees when they worked far less. Both nonprofit hospital systems did not admit wrongdoing in their settlements but signed corporate integrity agreements with the federal government requiring strict oversight.
“It’s almost a game of ‘We’re going to stretch the limits and see if we get caught, and if we get caught we won’t be prosecuted and we’ll pay a settlement,’” said Tom Ealey, a professor of business administration at Alma College in Michigan who studies health care fraud.
Dubious payment arrangements are a byproduct of a major shift in the hospital industry. Hospitals have gone on buying sprees of physician practices and added doctors directly to their payrolls. As of January 2018, hospitals employed 44% of physicians and owned 31% of practices, according to a report the consulting group Avalere prepared for the Physician Advocacy Institute, a group led by state medical association executives. Many of those acquisitions occurred this decade: In July 2012, hospitals employed 26% of doctors and owned 14% of physician practices.
“If you acquire some key physician practices, it really shifts their referrals to the mother ship,” said Martin Gaynor, a health policy professor at Carnegie Mellon University in Pittsburgh. Nonprofit hospitals are just as assertive as profit-oriented companies in seeking to expand their reach. “Any firm — it doesn’t matter what the firm is — once they get dominant market power, they don’t want to give it up,” he said.
But these hires and acquisitions have increased opportunities for hospitals to collide with federal laws mandating that hospitals pay doctors fair market value for their services without regard to how much additional business they bring through referrals.
“The law is very broad, and the exceptions are very narrow,” said Kate Stern, an Atlanta lawyer who represents hospitals.
‘A Man We Need to Keep Happy’
Lavish salaries for physicians with high potentials for referrals was the key to the business plan to turn Wheeling Hospital, a 247-bed facility near the Ohio River, into a profit machine, according to a lawsuit brought by Louis Longo, a former executive vice president at the hospital, and a companion suit from the U.S. Department of Justice.
Between 1998 and 2005, Wheeling Hospital lost $55 million, prompting the local Catholic diocese to hire a private management company from Pittsburgh, according to the suits. In 2007, the company’s managing director, Ronald Violi, a former children’s hospital executive, took over as Wheeling’s chief executive officer.
The hospital remained church-owned, but Violi adopted an aggressively market-oriented approach. He began hiring physicians — both as employees and independent contractors — “to capture for the hospital those physicians’ referrals and the resulting revenues, thereby increasing Wheeling Hospital’s market share,” the government alleged. Along with greater market share came the ability to bargain for higher payments from insurers, according to Longo’s suit.
The government complaint said at least 36 physicians had employment contracts tied to the business they brought to the hospital. Hospital executives closely tracked how much each doctor earned for the hospital, and executives catered to those whose referrals were most lucrative.
In 2008, the hospital’s chief financial officer wrote in an internal memorandum that cardiovascular surgeon Dr. Ahmad Rahbar “is a man we need to keep happy” because the previous year “he generated over $11 million in revenues for us,” according to the government’s lawsuit.
Dr. Chandra Swamy, an obstetrician-gynecologist the hospital hired in 2009, was another physician whose referrals Wheeling coveted. By 2012, Wheeling was paying her $1.2 million, four times the national median for her peers, according to Longo’s suit.
An internal memorandum by the hospitals’ chief operating officer quoted in Longo’s lawsuit said that the labor and delivery practice where Swamy worked was the biggest money loser among the specialty divisions and that her salary made it “almost impossible for this practice to show a bottom line profit.” But the memo went on to conclude that Wheeling should “continue to absorb the practice loss” because it “would not want to endanger the significant downstream revenue that she produces” for the hospital: nearly $4.6 million a year, according to the lawsuit.
In some cases it was the specialists who demanded lopsided pay packages. When Wheeling, eager to get a piece of the booming field of pain management, decided to recruit Tune, the anesthesiologist responded that he wanted an “alternative/undefined model” of compensation that could earn him $1 million a year, according to Longo’s lawsuit.
Instead of making Tune an employee, Longo alleges, Wheeling leased clinic space to a company created by Tune and paid him $3,000 a day — more than $700,000 a year. In its initial contract, Wheeling also let Tune keep 70% of his practice’s net income, according to the government’s complaint.
Two years later, when the hospital’s chief lawyer raised legal concerns, Wheeling revised the contract, dropping the profit-sharing provision but boosting Tune’s daily stipend to $6,100. The government complaint said this was designed to make up for the lost incentives and thus remained illegally based on how much business Tune generated for Wheeling. Indeed, Tune and his clinic earned roughly the same amount of money as they had received before the new compensation package, the complaint indicated.
Longo said his resistance to such deals rankled both Violi and physicians. He was fired in 2015 because, he alleged, of his objections to various contracts the hospital struck with physicians. The hospital countersued in March, saying Longo had breached his fiduciary duties because he never reported any financial irregularities when he worked there. Wheeling said that after Longo was fired, he threatened to file his lawsuit unless he received a settlement. Longo has asked that the case be dismissed and said in court papers he told Violi about his concerns on “multiple occasions.”
As a whistleblower, Longo is entitled to receive a portion of any money the government collects in its complaint. Longo’s lawyer said he would not comment for this story.
In financial terms, Wheeling’s tactics succeeded. According to the government’s suit, over the first five years under Violi, Wheeling earned profits of nearly $90 million. Violi’s management firm, R&V Associates, also prospered: Wheeling more than doubled the firm’s annual compensation from $1.5 million in 2007 to $3.5 million in 2018. Violi and his lawyer did not respond to requests for comment.
“The hospital has benefited tremendously from Ron’s keen business acumen,” Monsignor Kevin Quirk, the hospital board chairman, said last week in announcing Violi’s retirement.
Wheeling’s quality of care has not excelled commensurately, however, according to Hospital Compare, Medicare’s consumer website. Patients with heart failure or pneumonia are more likely to die than at most hospitals. In April, Medicare awarded Wheeling Hospital its lowest rating, one star, for overall quality.
03:07
Annapoorna
Elham Mirshafiei was at the library cramming for final exams during her senior year at California State University-Long Beach when she grew nauseated and started vomiting. After the 10th episode in an hour, a friend took her to the nearest emergency room. Diagnosis: an intestinal bug and severe dehydration. In a few hours, she was home again, with instructions to eat a bland diet and drink plenty of fluids.
That was in 2010. But the $4,000 bill for the brief emergency department visit at an out-of-network hospital has trailed her ever since. Mirshafiei, 31, has a good job now as a licensed insurance adviser in Palo Alto, Calif. But money is still tight and her priority is paying off her $67,000 student loan debt rather than that old hospital bill.
Once or twice a year she gets a letter from a collection agency. She ignores them, and, so far, the consequences have been manageable. “It’s not like electricity that gets cut off if you don’t pay it,” she said.
Mirshafiei has plenty of company. At least 43 million other Americans have overdue medical bills on their credit reports, a federal Consumer Financial Protection Bureau report on medical debt found in 2014. And 59% of people contacted by a debt collector say the exchange was over medical bills, the most common type of contact stemming from an overdue bill, according to the CFPB.
This month, the CFPB proposed a rule to frame what debt collectors are allowed to do when pursuing many types of overdue bills, including medical debt.
Federal law already prohibits debt collectors from harassing consumers or contacting them before 8 a.m. or after 9 p.m., among other things. But the law, which was passed in 1977, didn’t anticipate emails and text messages. The CFPB’s proposal clarifies how debt collectors can use these communication tools. And it would allow consumers to opt out of being contacted this way.
The rule also specifies that debt collectors can make no more than seven telephone calls weekly over a specific debt.
But some consumer advocates panned the effort. “This really doesn’t go far enough to protect consumers and make sure that consumers are not abused or harassed or subject to unfair collection practices in debt collection,” said April Kuehnhoff, an attorney at the National Consumer Law Center who specializes in debt collection.
For instance, the center wants a limit of just three telephone attempts each week on a debt. The seven-call limit could be particularly tough on people with medical debt, Kuehnhoff said. They may accumulate bills from several providers for a single medical event — hospital, doctors, a lab and a nursing home, for example — and all could be in collections separately, potentially resulting in dozens of calls each week.
Debt collectors aren’t necessarily in favor of the seven-call cap either, but for different reasons. They say that limiting the number of calls could lead to more litigation or adverse credit reporting rather than working out a payment plan. Overall, the proposed rule seemed to strike a good balance between collection industry and consumer concerns, said Leah Dempsey, vice president and senior counsel for federal affairs at ACA International, a trade group representing 2,500 debt collectors, asset buyers and related professions.
The general consensus is that people should pay their debts. But taking responsibility for medical debt isn’t always as straightforward as paying off a large-screen TV that someone put on a credit card. Did health insurance pay the correct amount? Was the person screened for eligibility for Medicaid, charity care or financial assistance?
“The actual debt collector problem is often about the lack of accountability that providers have for the people that they pass their debt along to,” said Leonardo Cuello, director of health policy at the National Health Law Program.
When a debt collector calls, consumers who are confused about the bill should ask, in writing and generally within 30 days, that the debt be validated. Debts are often bundled and sold multiple times to different collectors, which means errors may be introduced along the way. “There are no magic words; you don’t need to cite the statute,” said Justin J. Lowe, legal director at Health Law Advocates, a nonprofit law firm in Boston that helps people with low incomes who are having trouble accessing or paying for medical care.
At that point, the collection agency has to stop activities until it proves what the consumer owes. The proposed CFPB rule would spell out verification information that must be provided along with instructions for consumers about how to dispute the debt.
The proposal would also address other practices, including the collection of so-called zombie debt. That refers to a bill that has passed a time limit — or statute of limitations — for bringing legal action, often between three and six years, depending on the state. In many states, if a collector sues someone for such a time-barred debt, consumers can raise the issue in court in their defense. If a judge agrees, the case could be dismissed.
Consumer advocates have long wanted debt collectors to be prohibited from trying to collect zombie debt. After several years, it can be difficult for patients to remember whether a bill has been paid or to locate records, they argue.
The proposed CFPB rule would prohibit debt collectors from suing or threatening to sue consumers for zombie debt, but only if the collectors knew or should have known that the statute of limitations had expired. That puts the onus on the consumer to prove what was in the debt collector’s mind rather than merely showing that too much time had passed to collect.
While a college student in 2010, Elham Mirshafiei went to a hospital that wasn’t in her insurance network for treatment of an intestinal bug and severe dehydration. She still carries the $4,000 debt from that visit.(Courtesy of Elham Mirshafiei)
It’s unclear how the proposed changes announced by the CFPB might affect Mirshafiei’s situation. The statute of limitations in California on written contracts is four years.
One thing someone in Mirshafiei’s situation should be aware of is that making a payment could reset the statute of limitations, Lowe said. The debt collector could argue that by making a payment the person is affirming that he or she owes the debt.
Because of her damaged credit, Mirshafiei needed a relative to co-sign for student loans for graduate school. She worries that if she tries to buy a house, she’ll have trouble getting approved.
“I just hope that in the next chapter of my life I don’t have to be denied things because of this stain on my record,” she said.
As the federal government moves ahead with the rule to address various types of debt collection activities, legislators in a few states have introduced bills that specifically target medical debt. Their efforts often focus on improving access to financial assistance for medical care and limiting predatory debt collection tactics.
Last month, Washington Gov. Jay Inslee signed a law that reduces the maximum interest rate on medical debt prior to a court judgment from 12% to 9%. It also prohibits sending a medical debt to collections until 120 days after the patient is sent the initial bill and requires collection agencies to provide itemized statements to patients for medical and hospital debts and to notify them of their possible eligibility for charity care.
In Oregon, a bill sponsored by Rep. Andrea Salinas would require nonprofit hospitals and affiliated clinics to provide care free of charge to families with incomes up to 200% of the federal poverty level (about $43,000 for a family of three) and charge a sliding scale for families earning up to 400% of the poverty level (about $85,000 for a three-person family).
Like the Washington law, the Oregon bill places limits on the interest charged for medical debt. It also requires health care facilities to screen patients for eligibility for financial assistance and insurance.
The bill passed the House earlier this month.
Some hospitals already have strong financial assistance policies, but the playing field needs leveling, said Salinas. “We really need hospitals to be a part of the solution to prevent consumers from going into bankruptcy over medical debt.”
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The Food and Drug Administration has acknowledged that more than 56,000 never-before-disclosed surgical stapler malfunctions were quietly reported to the agency from 2011 through 2018.
The newly acknowledged reports were detailed in an executive summary for FDA advisers. The agency convened a meeting of experts this week to help it determine whether surgical staplers should be moved out of its lowest-risk category — reserved for simple devices like tongue depressors and bandages — to a higher grade that may require testing and additional oversight. Surgical staplers are used to cut and seal vessels and tissues inside the body.
When the FDA initially announced the meeting in March, it acknowledged in a letter to doctors that “many more device malfunction reports” were reported to the agency than it had publicly disclosed. The FDA executive summary published this week shows that the total reports more than doubled when the agency took nonpublic reports into account, totaling nearly 110,000 malfunctions or injuries from 2011 through 2018.
“It shocks the conscience,” said Chad Tuschman, a lawyer representing Mark Levering, 62, of Toledo, Ohio, who suffered a serious brain injury after a stapler malfunction caused massive bleeding in 2018. The surgeon, hospital and device maker Covidien, a division of Medtronic, have all denied allegations of wrongdoing in an ongoing legal case.
Surgical staplers have a unique ability to harm patients if they malfunction. Often used in minimally invasive surgeries, they are meant to both cut tissue and vessels and then quickly seal them. Patients have been gravely harmed when staplers have failed to fire or seal tissue, suffering from massive bleeding or infections if stomachs or intestines aren’t sealed properly.
The nonpublic reports were sent to the FDA as “alternative summary” reports, the topic of a recent Kaiser Health News investigation that focused on the agency accepting millions of hidden reports related to medical devices — including for surgical staplers.
The agency had previously acknowledged that in 2016, even as it posted fewer than 100 stapler-related injuries in a public database called MAUDE, it accepted nearly 10,000 reports into its little-known internal alternative summary reporting database. (The data in the FDA’s executive summary contains reports for staplers and staples, which experts have said were just different names for the same problem.)
Tuschman said he was stunned that there were more hidden reports than public ones in the executive summary. “The first question should be ‘Why?’ Why would they have the right to submit to a hidden database?”
Leading surgical stapler makers include divisions of Medtronic and Johnson & Johnson. Medtronic has said the FDA granted it exemptions for stapler-related malfunctions; Johnson & Johnson said it has not. (Ethicon is the name of its subsidiary medical devices company.)
On Thursday, the advisory panel recommended switching surgical staplers to a higher-risk classification with additional safety requirements, according to meeting attendee Jack Mitchell, director of health policy for the nonprofit National Center for Health Research. FDA spokeswoman Stephanie Caccomo declined to confirm this, citing a media office policy against telling reporters what happens at advisory committee meetings, which are open to the public.
“Every surgeon that I have ever worked with has had stapler failures,” said Dr. Doug Kwazneski, a Michigan surgeon who authored a survey in 2013 about “unacknowledged” stapler problems after searching the FDA’s public database of device incidents and coming up empty-handed.
“Going into something without data is dangerous,” Kwazneski said. “If the information exists, we should have access to it.”
More than 400 deaths have been reported since 2011 in the FDA’s public MAUDE database; fatalities can’t be reported to the alternative summary reporting database. Deaths were associated with Ethicon and Covidien products.
In recent communications about stapler safety to doctors, the FDA has advised against using the staplers on large blood vessels.
Kwazneski said surgical staplers are a time-saving tool, which lessens the risk of anesthesia complications during surgery, for example. But it’s important for physicians to remember they can fail.
Diana Zuckerman, president of the National Center for Health Research, said that alternative summary reports are “a well-kept secret” and that any reports related to their existence were “done in a way that was not understood as a repository for hundreds of thousands of serious adverse event reports.”
Mitchell said he was surprised the FDA didn’t reclassify surgical staplers “a long time ago,” considering the agency had the additional 56,000 alternative summary reports all along. “They were the only ones who had this information, and it was nonpublic.”
Kwazneski suspected that there were a high number of hidden reports for stapler malfunctions, but he said the numbers revealed in the FDA’s executive summary still came as a shock.
“The sheer magnitude of seeing it all at once kind of blew my mind,” he said.
Staplers lost their eligibility to report malfunctions through the hidden system in February 2019, and the FDA announced it would end the alternative summary reporting program earlier this month. It has promised to make that data public in the “coming weeks.”
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Enables deep planning to optimise demand-supply across a global customer base
Pune, India – May 30, 2019: Sterlite Technologies Ltd (STL) [BSE: 532374, NSE: STRTECH], a global leader in end-to-end data network solutions, has invested in an integrated system to radically shift global customer experiences by building robust planning and delivery processes.
With customers spanning across countries in Asia, Europe, the Middle East and Latin America, manufacturing facilities in three continents, and a diverse data network solutions set, STL has a fairly complex demand-supply network. The Company also recognises that the speed of global serviceability is a priority when designing and orchestrating complex supply chains.
To help ensure a speedy and smooth implementation, STL designed an organic transformation recipe to enable rapid implementation of planning processes and tools. As a result, it selected SAP Integrated Business Planning solution and GitaCloud as the implementation partner for the solution. STL’s unique selection framework for deep planning is based on several attributes such as product features, adaptiveness, configurability and domain knowledge.
“Well, this is just the beginning! STL’s digital transformation roadmap has a lot more to offer –across its blocks of foundational, scalable and ‘moon-shot’ processes – to enrich customer experience and enable speed with our scale-up. We plan to inseminate a digital collaboration model with our growing customer and supplier base to enable near-real time planning and orchestration to delight customers with a very responsive supply chain,” said Nischal Gupta, Chief Transformation Officer at STL.
“SAP is excited to support the ongoing digital transformation at STL. SAP Integrated Business Planning, part of the SAP Digital Supply Chain platform, enables global end-to-end planning, providing STL deep business insight and delivery excellence to meet their next phase of customer experience,” said Paul Marriott, Senior Vice President, Digital Core Cloud, SAP Asia Pacific Japan.
“STL has an ambitious and holistic transformation vision. We are very pleased to have delivered the first phase of this transformation successfully, and look forward to rolling out the solution globally. We are committed to delivering optimal planning across demand, supply and scheduling to enable perfect order performance along with optimal cost to serve the demand,” said Ashutosh Bansal, President and CEO, GitaCloud.
About Sterlite Technologies Ltd - STL
STL is a global leader in end-to-end data network solutions.
We design and deploy high-capacity converged fibre and wireless networks. With expertise ranging from optical fibre and cables, hyper-scale network design, and deployment and network software, we are the industry's leading integrated solutions provider for global data networks. We partner with global telecom companies, cloud companies, citizen networks and large enterprises to design, build and manage such cloud-native software-defined networks.
STL has innovation at its core. With intense focus on end-to-end network solutions development, we conduct fundamental research in next-generation network applications at our Centres of Excellence. STL has strong global presence with next-gen optical preform, fibre and cable manufacturing facilities in India, Italy, China and Brazil and two software-development centres.
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Media Relations
LK Pathak
+91 9925012059
L.k.pathak@sterlite.com
Investor Relations
Vishal Aggarwal
+91.20. 30514000
Vishal.aggarwal@sterlite.com
Corporate Communications
Sumedha Mahorey
+91. 22. 30450404
Sumedha.mahorey@sterlite.com
About GitaCloud
Incorporated in Delaware, GitaCloud is on a mission to improve integrated business planning and decision making competencies at its clients. GitaCloud Principals come from a rich background of helping dozens of leading Fortune 500 companies through their business transformation in Sales & Operations Planning, Demand Planning, Supply Chain Planning & Optimization domains. GitaCloud offers a full range of services: business transformation advisory, reselling best of breed cloud software, Systems Integration engagements, and Supply Chain Managed Services. GitaCloud clients range from Automotive, High-Tech, Pharmaceutical, Consumer Goods, and Retail verticals across North America and Asia Pacific markets. For more information, please visit www.GitaCloud.com.
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