Recently, the federal government stated the average household income was $46,000. The average health insurance policy was $1,300 per month or about $15,600 per year. Now there are more households and individuals than ever who cannot afford insurance.

In the US there are 46 million people now without health insurance, which is approximately 16% of the population. Nevada ranks 42nd in children without health insurance. This ranking has actually improved from 46th in 2003, but we still have a long way to go. More than 18% of children in the state of Nevada under the age of 18 years old are without health insurance. There is a national goal that by 2010 all children have health insurance.

Some states are working on universal health plans; others are starting with mandatory insurance for all children under the age of 5. Some governors are making a big push on the access issue at state levels. In Kansas, Governor Kathleen Sebelius said she wanted the state to cover every child from birth to age 5. In New Mexico, Governor Bill Richardson had similar plans for about 20,000 uninsured children. He said, "this is unacceptable, and no one in this room should tolerate it, which is why we should work toward the goal of insuring all kids under 5 years old." Our governor has been very active on health care access, fighting to prevent the 5% Medicare reduction and supporting tort reform for access. Governor Gibbons has created the Healthcare Committee Transition Team to guide and advise him on health care issues in Nevada.

The team is composed of about 30 individuals and is chaired by Dr. Rudy Manthei. "This group," he said "is large and diverse. It is a fine collection of people who care about the future of our state and specifically our ability to provide health care to our citizens and the tourists that love this state."

The team has been divided into several subcommittees such as Medicaid, the uninsured, technology and graduate medical education. In this article I've chosen to focus on Medicaid and the uninsured.

I am a member of the Medicaid subcommittee, chaired by Larry Matheis. The 2005-2007 state budget authorized $1.1 billion for health care programs. This is a large part of the total state budget of $3 billion. There are about 200,000 to 250,000 Medicaid recipients in the state, with more than 28,000 children in Nevada Check-Up programs. About 70% of the Medicaid recipients and all Nevada Check-Up recipients are enrolled in one of two state coordinated HMOs - Sierra Health Services or Anthem Blue Cross.

According to Larry, "over 70% of the Medicaid expenditures are for those patients who are not in the HMOs, persons with disabilities and patients in institutional care. The federal share of Medicaid program cost is 50% and for the Nevada Check Up (SCHIP) program is 60%.

A large focus was on enrolling eligible uninsured individuals into existing programs sooner rather than later. Without insurance, many indigents don't seek medical care until their health problems reach crisis proportions, such as no or poor prenatal care with increasing maternal and infant morbidity and mortality. The committee wants to explore other programs which will aid in better out-patient care leading to less hospitalization, such as developing a Medicaid medication therapy management program, for illnesses such as diabetes, HIV, congestive heart failure and cancer. Such programs exist in the private sector through better patient education, medication regulation, better patient compliance is achieved and less costly hospitalizations occur.

A recent national survey shows that approximately 67% of all mothers in Nevada receive prenatal care; one in three pregnant woman do not receive prenatal care. Nationally, 84% of all mothers receive prenatal care. Nevada ranked 49th, above only New Mexico. The national goal for 2010 is 90%. The majority of the work group supports a recommendation that the state Medicaid program should consider removing obstetrical coverage from the HMO contractors and provide obstetrical coverage as direct Medicaid since Sierra no longer goes to HCA hospitals, Sunrise, Mountain View, etc. Sierra Health Services is limited in what it can offer the Medicaid patient. The Medicaid pregnant population has a number of high risk pregnancy patients, and gives birth to a large number of infants with high morbidity and mortality. The Valley and Summerlin hospital neonatal units are currently on divert. The Summerlin neonatal unit has 9 beds but 16 patients. Their unit is overburdened. This is when problems arise. Last month a neonatal death occurred at Summerlin subject to a medication error and drug overdose. Is it right that a Medicaid patients, which are known to be high risk, are not able to have better access to health care? It is not right; it is also unconscionable. These patients should be allowed better access to doctors and hospitals in their own area. For many of them it is difficult to travel very far. These patients should be allowed access to the inner city hospital and its neonatal unit which is in their own backyard and is one of the best neonatal units in the nation. When Dr. Feldman came to town in 1974 the neonatal mortality rate was 19 per 1,000. By 1985 it had dropped to 4 per 1,000, the best rate in the country. It is the responsibility of the state to look at the program offered to our most vulnerable population and do what it can to make it better. Nevada frequently ranks badly in most categories. There is one category that historically Nevada has done well in, infant/child mortality, but has recently slipped. It now ranks 13th in infant mortality rates, which is a decline from 9th. If we are underutilizing our largest and best neonatal unit, is this likely to get better?

One of the other things being considered for recommendation to the state Medicaid program is that professional payment rates be revised to adapt to the current Medicare schedule and be annually updated. The AMA recently reported Physician payment rates are going up in at least 24 states, but there is lot of lost ground to make up. This year at least two dozen states will increase their Medicaid reimbursement rates to doctors. After years of increases and years of inflation and often rising costs and malpractice increases, they will provide an average of 2-3% increase. The raise will generally apply across the board to all physicians. In Massachusetts, as part of the Massachusetts Health Program they will be increasing Medicaid rates by 5-6% for most specialties. Even in the past Massachusetts has had an average Medicaid increase each year of 2-3% from 2001-2006. We must get Medicaid rates to meet doctor's expenses, without such actions fewer and fewer doctors will be able to care for Medicaid patients.

Also the Medicaid committee recommends that prompt payments must be made to Nevada doctors who take Medicaid. Nevada's Medicaid program should increase hospital payment levels at least by the amount of inflation. Also for patients with straight Medicaid, the hospital would be reimbursed at 100% Medicaid instead of 70% (Sierra takes 30%). If you consider that 50% of deliveries in Nevada are covered by Medicaid this would be helpful for our hospitals who are now struggling with uninsured and Medicaid. In Texas last year 7 hospitals went bankrupt from helping indigent and uninsured patients and not being able to cover costs. Why shouldn't our hospitals get paid the straight Medicaid fee? Allowing payments to pass through the checking account of an HMO is like a transfusion with a leaky tube!

The committee is also working on the issue of the uninsured. In the July 2006 president message I discussed the bill passed in April, 2006, by the Massachusetts legislators to cover the uninsured. It is the first state to have a universal health plan. The plan mandates all residents to have insurance (penalties include loss of personal tax exemption); the bill requires employers to pay $295 per uninsured worker (penalty of a surcharge for employers who don't offer health plans) to create a commonwealth insurance connection, which will certify insurance products and merges individual and small group insurance markets (decrease premiums) creates the subsidized "commonwealth Health Insurance Program" for those ineligible for Medicaid but with very low income. Finally, include 81 million boost to physician Medicaid reimbursement over three years. The Committee is meeting now; it will be interesting what they propose. Will they suggest tax credits or other subsidies to expand Health coverage?

The committee was very supportive of some type of universal health plan. Also, they were supportive of a program for insuring all children. One big problem for Nevada compared with other states such as California and Massachusetts is that we cannot utilize the state income tax system as part of the program. It will be very challenging for us to create a universal health insurance without such a system in place. Since many of the other universal programs use the tax system to give credits or penalize, and to simply track all participants.

Other suggestions to help the uninsured include: creating clinics run by volunteers and retired physicians. Dr. Garn Mabey suggested something similar to what is happening in Vermont. Senator Barbara Cegavske recommended creating a bill to be able to utilize unused medicine. To better utilize state programs that are available, there are many programs that exist, such as Nevada Check Up, that are not fully utilized.

At CCMS, in the public health committee we have been working on a webpage to connect physicians with community groups to provide health care to the needy. Please see our website. Next month I will go into more details about our future goals for this program. It has the potential of helping thousands of medically needy through different avenues.

The AMA plan for reducing the ranks of the uninsured includes expanded coverage and choice through refundable tax credits inversely related to income and individually owned and selected health insurance. Also, it calls for wide range of new, affordable insurance options. Right now many doctors offices can no longer afford to offer health insurance to their staff. St Mary's PPO has a plan it is providing for Washoe County Medical Society, which has about 1,000 physicians and staff participating, with excellent rates. Dr. Coppola and other physicians at WCMS worked a long time to develop this program. Thank you to WCMS and its staff. CCMS is currently investigating this plan, we hope it will be an affordable plan that will allow many Clark County practices to participate and provide coverage for themselves and their staff. I will keep you informed of developments.

The projection is that premiums will continue to rise, although hopefully slower. As premiums go up, more people rely on Medicaid. How much can Medicaid handle? It is already a severe strain on the state budget, accounting for roughly one third of the budget.

Discussing health care reforms of our Medicaid system, the uninsured, universal health care, is quite overwhelming. We would love to believe it is not so bad or that it will not get much worse, not likely! Just as sure as the sun will come up tomorrow, the number of uninsured in Nevada will continue to grow and grow, and the consequences will be devastating for some. Therefore, let us all work together to make much needed health reforms to provide better access to health care and better health care for the people of Nevada. Please support organized medicine and the government to bring about much needed changes in health care. I encourage you to get involved; we will need the leaders starting at the state level. It is not likely that needed changes will come anytime soon from the Federal government. Now is the time to volunteer to be a member of the house of delegates for the NSMA. Please contact CCMS.

It has never been truer to say that an ounce of prevention is worth a pound of cure!

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Clark County District Court Medical Malpractice Filings

Against Health Care Providers, Jan 2001 –Dec 2006

2001 2002 2003 2004 2005 2006

Jan 39 33 108 61 41 50

Feb 20 14 98 72 63 61

Mar 35 30 169 123 64 38

Apr 37 34 111 81 70 58

May 37 35 126 65 14 71

Jun 27 24 103 90 65 83

Jul 19 100 114 45 66 74

Aug 54 51 76 67 33 82

Sep 20 65 105 79 36 51

Oct 37 83 110 59 26 74

Nov 38 184 59 78 68 50

Dec 9 170 67 47 30 28

Sum 372 823 1246 867 581 720

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Member News

Congratulations and Welcome to the Clark County Medical Society New Members - December 2006

· Pauline L Chao, MD - Internal Medicine, 5380 S Rainbow Blvd 306, Las Vegas, NV 89119

· Aaron J Goodrum, MD – Radiology, 2555 Montessouri St C, Las Vegas, NV 89117

· Ashok K Gupta, MD – Radiology, 2020 Palomino Ln 100, Las Vegas, NV 89106

· David S Lin, MD - Diagnostic Radiology, 2555 S Montessouri St C, Las Vegas, NV 89117

· Alan J Sacks, MD - OB-GYN, 2020 Goldring Ave 404, Las Vegas, NV 89106

Congratulations and Welcome to the Clark County Medical Society New Physician Assistant Members - Dec 2006

· Dar Stone, PA - Supervising Physician, Rafael Juarez, MD

Applicants to Go Before Credentialing Committee

· Lin-Chi Chen, MD - Internal Medicine

· Camille A Falkner, MD - Ob-Gyn

· Zahid Hamid, MD - Internal Medicine

If you have any pertinent information about these membership candidates, please contact: Clark County Medical Society, 2590 E. Russell Rd., Las Vegas, NV 89120

For information on becoming a member of the Clark County Medical Society, call Janiceanne Poblete at 739-9989.

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Attention All Members: The Clark County Medical Society will pay you to be a Delegate!

$500

Delegates must be present for roll call at the meetings on both Saturday and Sunday to qualify for the $500.

Call the Medical Society at 739-9989 to sign up.

The annual Nevada State Medical Association meeting will be held in Sparks, Nevada at John Ascuaga's Nugget from

April 27-29, 2007.

Why attend?

· To interact with the people who deal with tort reform, who coordinate efforts for all legislative medicine-related issues and who deal with the regulatory issues that affect us every day

· To voice your opinions about the mission and purpose of our organization. Do you see a need for change? Now's your time to be heard

· To exchange ideas with physicians from throughout the state and from many specialties about many topics - from problems with hospitals or insurance companies, to public health issues

· To participate in CME which will cover

several different timely topics

· To have fun! There are many events for members and spouses or guests to enjoy

To find out more, call Nancy Sommer at the Society, 739-9989, or any board member.

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Southern Nevada Health District Report

New health district regulations expand reporting requirements

By Donald S. Kwalick, MD, MPH, Chief Health Officer, Southern Nevada Health District

On November 16, 2006, the Southern Nevada District Board of Health approved new regulations regarding the reporting of diseases to the Southern Nevada Health District. The regulations were subsequently approved by the Nevada State Board of Health, and became effective on December 8, 2006. These regulations, entitled "Regulations Governing the Reporting of Diseases, Exposures, and Sentinel Health Events," supplement the provisions for disease reporting set forth by Nevada Revised Statutes (NRS) Chapter 441A, and Nevada Administrative Code (NAC) Chapter 441.

These new requirements were developed to work within the existing framework for disease reporting. Although additional conditions are now reportable, the process by which they are reported is the same. In addition to required reporting by laboratories and health care providers, non-medical first responders, and the management of a facility at which an incident has occurred are also required to report diseases, exposures, and sentinel health events. This new provision is of particular importance in identifying outbreaks and drowning, as patients involved may not require transport to a medical facility or additional medical care.

The provisions of these new regulations have recently been exercised with the new requirement to report West Nile infections in Southern Nevada. A temporary statewide reporting requirement expired on September 23, 2006. The health district felt it was important to continue to track reports in order to allow staff to investigate the circumstances of the case and to implement control measures to prevent additional cases. This temporary requirement took effect on January 2, 2007, and was announced in a technical bulletin distributed to health care providers. The requirement will expire on January 2, 2010, unless renewed or made part of permanent reporting requirements.

Reports should be made to the Southern Nevada Health District by phone at (702) 759-1300, option#2, or by fax at (702) 759-1414. Disease reporting forms are available on the health district website. These temporary requirements are effective as of January 2, 2007. Per county regulations, the requirements will expire on January 2, 2010, unless renewed or made part of permanent disease reporting regulations.

New conditions to be reported include the following:

· Elevated Toxic Metal Levels: Patients identified as a having detectable levels of arsenic, lead, or mercury in blood, urine, or other clinical specimens

· Toxic Metal Exposures: Known exposures of patients to arsenic, lead, or mercury

· Drowning: Drowning is defined as "The process of experiencing respiratory impairment from submersion and/or immersion in liquid"

· Drug-Resistant Streptococcus pneumoniae Invasive Disease: A person with Streptococcus pneumoniae in the blood or cerebral spinal fluid (CSF), with intermediate or high-level resistance of the isolate to at least one antimicrobial agent

· Group A Streptococcal Invasive Disease: A person with Group A Streptococcus in a normally sterile site

· Pediatric Streptococcus pneumoniae Invasive Disease: A child less than 5 years of age with Streptococcus pneumoniae found in the blood or CSF

· Vancomycin-intermediate Staphylococcus aureus (VISA) and Vancomycin-resistant Staphylococcus aureus (VRSA) Infection: A person with Staphylococcus aureus, with intermediate or high-level resistance of the isolate to vancomycin found at any site

· Vibriosis, Non-Cholera: pathogenic Vibrio spp. organisms, other than Vibrio cholerae, found in stool, vomitus, wound, blood, or other sterile site (Cholera is still reportable per NAC 441A)

· West Nile Virus: The identification of West Nile Virus in any patient specimen (including those collected at blood banks), through antigen, antibody, or culture

· Communicable Disease Outbreaks: Outbreak of communicable diseases, including those diseases which are not individually reportable

· Exposures of Large Groups of People: An exposure is defined in these regulations as "Contact with a biological, chemical, radiological, or other agent or situation that can affect health." Exposures of groups of people, such as in a chemical spill or exposure to a disease-causing organism should be reported

The complete text of the regulations can be found on the Southern Nevada Health District website at http://www.southernnevadahealthdistrict.org. Individual questions should be directed to Brian Labus, MPH, Senior Epidemiologist by phone at (702) 759-1300, or by email at labus@shndmail.org.

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Alliance Message

By Pauline Lee & Andrea Yu, 2006-07 CCMS Alliance Co-Presidents

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Federal Statute Pushes for Expanded State Medicaid False Claim Laws

By Weldon (Don) Havins, M.D., Esq., Executive Director, Special Counsel, President-elect, Clark County Medical Society

In February 2006, President Bush signed the Deficit Reduction Act (DRA) of 2005. A portion of this law provides for states to receive 10% more income from actions against Medicaid providers engaged in fraud. To receive this largesse, the state must comply with the many specific provisions within the DRA. Among the requirements: states must promulgate laws matching or exceeding the federal False Claim Act (FCA) penalties and provide for qui tam (whistleblower) rewards equal to or greater than those available under the federal law. Under section 6035(e) of the DRA, if state legislation is needed for the state's Medicaid plan to meet the DRA requirements (as it is in Nevada), the state will not be deemed out of compliance until the first day of the first quarter after its next regular session after February 8, 2006 (July 1, 2007 for Nevada). Thus, for Nevada to benefit from the DRA, state law will need to be amended to be equal to, or more severe than, the federal False Claims Act.

Implementation of this new law will mark a significant change in Nevada Medicaid fraud law. NRS 422.540 provide that a person with intent to defraud commits an offense if he: 1) by commission or omission makes or causes to be made a false claim; 2) makes or causes to be made a statement or representation to obtain authorization to provides a specific good or service, knowing the statement or representation to be false, by himself or for another; or 3) makes or causes to be made a knowingly false statement or representation for use in qualifying as a provider. If the amount involved is $250 or greater, the offender is guilty of a Class D felony. A Class D felony provides for no less than 1 and no more than 4 years imprisonment. If the amount involved is less than $250, the offender is guilty of a misdemeanor.

Under the federal FCA, criminal penalties, and in particular, the Medicaid fraud criminal penalties, are much more onerous. When the amount involved is greater than $250,000, the federal act provides that, "whoever, having knowledge of the occurrence of any event affecting his initial or continued rights to a benefit or payment [from a federal health program] … conceals or fails to disclose such event with an intent to secure payment in a greater amount than is due or where no such benefit is authorized" is guilty of a felony. Such felony provides for up to 5 years imprisonment and up to a $250,000 fine.

However, in assessing penalties for false claims, civil monetary penalties are assessed far more often than are criminal penalties. The Nevada False Claims Act provides for civil penalties of not less than $2,000 or more than $10,000 for each false claim. Under the federal FCA, a person committing fraud is subject to a civil penalty of $5,000 to $10,000 for each fraudulent act plus treble damages (of the amount billed or received). Thus, for 100 submissions of $100 knowingly false claims, the offender is subject to treble damages of $30,000 plus a fine of a minimum $500,000 to a maximum of $1,000,000. The offender is also subject to removal from all federal medical provider programs.

Also under the federal FCA, qui tam whistleblower actions are permitted. A person with "original source" (direct and independent) knowledge of the fraud can bring a claim in federal court, prosecute the claim in the name of the government, and claim up to 30% of the eventual award against the defendant if the government does not intervene by assuming the prosecution in the case. In some cases, this has resulted in the qui tam relator receiving several million dollars, plus attorney fees and costs. Even when the government does intervene, the qui tam relator receives from 10% to 25% of any recovery.

History of the motivation for the DRA provisions

After hearings on Medicaid fraud in Senate Committee on Finance in June, 2005, three conclusions were reached: 1) there was rampant fraud, waste, and abuse associated with the Medicaid prescriptions drug benefit; 2) the federal government was not doing enough to fight it; and 3) the Federal False Claims Act is an important and effective tool for controlling Medicaid fraud. Shortly thereafter, the General Accounting Office (GAO) issued a report entitled, "Medicaid Fraud and Abuse: CMS's Commitment to Helping States Safeguard Program Dollars is Limited." The GAO report indicated that Medicaid covered over 54 million individuals with costs of $261 billion, but that CMS supervision of state fraud and abuse control activities was woefully inadequate, with a total of just eight employees assigned to oversights in 2005. Federal review of state Medicaid program safeguards was occurring no more than once every seven years, and, despite millions of dollars CMS was receiving from the statutorily established fraud and abuse control fund, CMS did not allocate resources to sufficiently fund initiatives to help states increase their Medicaid fraud and abuse control efforts. The Senate Finance Committee, as noted above, reacted to the report by authoring Section 6032 of the Deficit Reduction Act.

What must the Nevada legislature do to comply with the DRA?

The Nevada Attorney General's office wrote the Department of Health and Human Services to formally inquire whether and to what degree Nevada law complied with the DRA mandates. The response, dated December 21, 2006, from the Inspector General of HHS indicated that Nevada law is deficient in two fundamental aspects: in the statute of limitations for the filing of claims, and in civil penalties for fraud.

The federal FCA provides that a civil action must be filed no more than 6 years after the date on which the violation is committed, or no more than 3 years after the date when facts material to the right of action are known or reasonably should have been known by a federal government official charged with responsibility to act, but in no event more than 10 years after the date on which the violation is committed. The Nevada FCA requires an action to be filed no more than 3 years after the date of discovery of the fraudulent activity by the AG or no more than 5 years after the fraudulent activity occurred, whichever is earlier. In this regard, Nevada law is not at least as effective in facilitating qui tam actions for false or fraudulent claims as the federal FCA. To comply, Nevada must extend the statute of limitations in which a claim may be brought against a healthcare provider to the federal limits.

For civil penalties, the DRA provides that state law must contain a civil penalty that is not less than the amount authorized under the federal FCA. As mentioned above, the Nevada FCA civil penalties are substantially less than the federal FCA's penalties of $5,000 to $10,000 for each fraudulent action.

The Education Requirement in the DRA

Relatively few Nevada state qui tam actions have been filed by “private plaintiffs”. Some feel the primary reason for this is the general ignorance of healthcare provider employees regarding the qui tam state law provisions. This ignorance will change due to the provisions of Section 6033. This provision makes compliance programs and education about the federal and state FCA mandatory for entities that receive $5 million or more in Medicaid funds annually. In particular, this provision amends the Social Security Act to require state Medicaid programs to:

1. Establish written policies for all employees of the entity and any contractor or agent of the entity to provide detailed information about the federal FCA, any state laws pertaining to civil or criminal penalties for false claims and statements, the whistleblower protections under the federal FCA and under state laws, and the role of such laws in preventing and detecting fraud, waste, and abuse in federal healthcare programs.

2. The entity must also provides detailed information regarding the entity's policies and procedures for detecting and preventing fraud, waste, and abuse.

3. Any employee handbook must specifically discuss the above information.

Section 6033 applies whether or not Nevada's Legislature chooses to amend Nevada's FCA. State Medicaid programs must implement this section by January 1, 2007 or face loss of all Medicaid funding along with any other funding under state-administered, federal healthcare programs under the authority of the Social Security Act. If a provider receiving more than $5 million in annual Medicaid reimbursement does not comply, that provider will lose all its Medicaid funding. Compliance programs, formerly voluntary, are now mandated under the DRA. Affected healthcare providers and entities will be challenged with the necessity of providing educational material in their policies, procedures and employees handbooks without unjustifiably creating whistleblowers in their organizations.

While the education requirements are mandated only to larger Medicaid providers, it is foreseeable that the information provided to employees, contractors, and agents of the healthcare providers will disburse that information throughout the medical community. Physicians' employees are likely to learn the details of proceeding with a qui tam action. One can also foresee more plaintiff attorneys advertising their services as qui tam relator counsel.

Qui Tam Actions

Nevada's current False Claims Act, the details of which are enumerated in NRS 357, provides that a private plaintiff (Nevada's term for the qui tam relator) may bring an action against a person or an entity involved in fraud involving state money, property, or services. The relator, who is generally an employee or former employee with original source knowledge of the fraudulently submitted claims(s), submits the information, in detail, in a sealed (non-public) filing with the court (State District Court). Upon filing the complaint under seal, the private party sends the Nevada Attorney General a copy of the complaint with all relevant information. The complaint remains sealed until the AG elects whether to intervene in the case. The AG has 120 days to decide whether to intervene, although the AG frequently files a motion (which is routinely granted) for an extension of time. If the AG intervenes, the private plaintiff will receive no less than 15% nor more than 33% of any recovery. If the AG declines to intervene, the private plaintiff proceeds against the healthcare provider in court, in the name of the state. In this instance, the prosecuting qui tam relator then obtains 15% to 25% of any recovery against the physician. If the case proceeds to trial, the successful relator will obtain costs against the physician. The relator can also ask for "reasonable attorney fees" incurred in prosecuting the case.

Prior federal cases have included employees who have suggested the fraudulent activity to the physician and who have implemented the fraudulent billing. These employees often have received a portion of the illegal proceeds in their share of the scheme. These employees have then become qui tam relators and successfully sued their former employers, with or without intervention by the U.S. Attorney General, and have received their "reward" percentage.

Because employees, and former employees, often serve as qui tam relators against physicians, prudence demands that physicians become intimately involved with the details of their Medicaid billing to assure it is being done in a proper manner. Deliberate ignorance or reckless indifference of the fraudulent billing practices are both considered "knowing" involvement in the fraudulent billings by the physician.

If a physician has been involved in questionable billing practices involving federal healthcare programs, the physician may want to consider voluntary disclosure of this information in an effort to avoid a qui tam or government action. If a person makes a voluntary disclosure of behavior that creates liability under the False Claims Act, the potential penalty is limited to double damages. The voluntary disclosure must be made by the person or entity that violated the FCA, made to officials responsible for investigating violations (DOJ, HHS' OIG, or state AG), and made within 30 days after the provider first obtains information about the FCA violation. Again, the advantage of voluntary disclosure is that damages are limited to double the amount fraudulently billed, and the onerous fines of the FCA do not apply. For healthcare providers who have knowledge (or have been “intentionally ignorant”, or “recklessly indifferent”) of the improper billing greater than 30 days, consultation with an experienced attorney who can negotiate with the authorities would be prudent.

Conclusion

In sum, Nevada physicians should be aware of the likelihood of this Nevada Legislature opting to amend Nevada Revised Statutes to comply with the Deficit Reduction Act of 2005. The amended Nevada law will apply to all future false claim and fraud cases, not just to those involved in Medicaid billing. The education mandate, which will provide detailed information about filing qui tam actions, will likely motivate employees, former employees and former associates to consider filing qui tam actions in either state court (for Medicaid fraud) or in federal court (for all other federally funded healthcare programs). The number of physicians accused of improper or fraudulent billing practices will likely grow.

Physicians should investigate their billing departments to assure that claims are being billed appropriately. Physicians should be particularly sensitive to inappropriate upcoding, unbundling codes, lack of supervision when the codes require supervision, billing for services lacking indicia of medical necessity, and of course, billing for services not performed. These are among the most common allegations basing a qui tam claim. Physicians accused of fraudulent billing practices should consult an experienced attorney at the earliest opportunity. Physicians who believe they may have been involved in fraudulent billing may wish to consider voluntary disclosure to minimize financial penalties. An experienced attorney can be invaluable in negotiating a satisfactory outcome.

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Minutes

CLARK COUNTY MEDICAL SOCIETY BOARD OF TRUSTEES MEETING

MINUTES SYNOPSIS

Tuesday, October 17, 2006; 6:00 P.M.

Minutes (September 2006)

The minutes from the September meeting were approved unanimously.

Financial Report

The revenue for September was $108,715.84. Our expenses were up slightly from last year at this time. The expenses for September were $32,720.31. The bank account balance at the end of September was $412,361.70. Martha Ford, CPA, from auditor PBTK, explained the analytical test for the dues revenue.

Membership Report

There were 539 dues-paid members; last year at this time there were 524 paid members. Total including dues exempt members was 664. Dr. Stacy Garry was approved for inactive status.

Medpac Committee

Medpac contributed $2,000 each to the two Nevada State Supreme Court candidates; Dianne Steel and Nancy Saitta, and $1,000 each to Senator Barbara Cegavske and Sandra Tiffany. This leaves enough money for anticipated audit costs.

Credentials Committee

The following members were approved for active membership: Harry W Donias, MD - Cardiothoracic Surgery, Michael D Gouvion, MD - Diagnostic Radiology, Margaret Terhar, MD - General Surgery.

Community Health/Relations Committee

The Community Health/Relations Committee met on October 10th. A website committee was formed. Additionally, they plan to continue to develop the volunteer services. They are working with the Purple Bus and COW Bus and more information will be provided at a later date. Michelle Turshinsky was introduced as the new office manager and offered to help with updating the website. She invited the board members to e-mail any suggestions to her.

Alliance

Andrea Yu stated the membership event was successful. She urged the board members to participate in the annual holiday greeting card project which will fund nursing scholarship awards. At the end of the month the alliance will be attending a rally for "Yes on 5, No on 4".

Health District Report

Dr. Kwalick was unable to attend but provided a written report to the Board on current Health District concerns. Staff was directed to ask Dr. Kwalick how Nevada preschool vaccination rates compare to other states.

UNSOM Report

Dr. Lenhart thanked the board for supporting the Health Sciences Center's recent fundraiser which was a huge success. The Board changed the name in the Medical Society's goals from Academic Medical Center to Health Sciences Center.

NSMA Report

Dr. Wayne Hardewick updated the board members on current NSMA issues. He stated NSMA is in good financial shape and recently evaluated staff and gave raises. Larry Matheis reminded the board members that the AMA meeting will be held in Las Vegas during the second week in November.

NBME Report

Dr. Rodriguez stated the BME sent brochures to all of the doctors and that he participated in a public service announcement on that same topic.

Administrative Report

Dr. Havins stated that the Clark County Medical Society was recently re-incorporated due to the fact that the original articles of incorporation had expired after fifty years. The society is now perpetually incorporated. Per the Board's request, a quote to replace the board room chairs was presented. This issue did not move forward due to lack of a motion.

Presidents Report

Dr. Jameson stated that on July 1st, 2007 Dr. Havins will become CCMS president and that this Board needed to decide whether or not he should remain Executive Director while serving as president. After lengthy discussion, it was decided that Dr. Havins will serve as president of CCMS and remain Executive Director.

New Business

Dr. Serfustini was concerned about insurance companies dropping doctors from their provider lists who cut down on hours or scope of practice. He will bring this issue back to the board when he obtains more information.

Future Meetings

The next monthly meeting for the Board of Trustees will occur on November 21st, 2006 at 6:00pm.

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Attention All Members: Board of Trustees Elections are Upcoming

The Nominating Committee's slate for the 2007-08 Board of Trustees will be mailed to the entire membership in March.

If you are interested in becoming a nominee, please inform the CCMS staff at 739-9989

as soon as possible.

2007 Nominating Committee

Michael Verni, MD - Chair

Michael Colletti, MD

Warren Evins, MD

Ron Kline, MD

Frank Nemec, MD

Ronald Slaughter, MD

Carol Vanderharten, MD

Per the CCMS bylaws, the committee must choose their slate from physician members having two or more years membership. If you are not on the Nominating Committee’s Slate, you can still be nominated by any voting member. Your endorsement must bear the signature of 4 voting CCMS members in good standing. All nominations must be submitted in writing before April 15, 2007.

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Classifieds

Practice & Equipment for Sale: Family Practice, mostly Medicare and contracted FFS. Equipment includes surgical instruments, business machines, computers, chairs, stools and exam tables. Not available until April 1st. Call 733-8803 if interested.

Need Internist or Family Physician: will provide new office/full staff support, EMR, X-rays. Set your own hours, full or part time. Email resumes at staff@childrensurgentcare.com or call at 898-6400.

FOR LEASE: 4000(+/-) sq.ft. W. Charleston frontage, one story, ample parking, Close proximity to VALLEY & UMC hospitals and freeways. Build to suit. Call cell #702-232-3344.

Office space (1700 sq ft) available: for sublease in central location (2020 Goldring) near Valley/UMC. Currently seeing surgery patients half day 1-2x /wk. Call 688-1343.

OB/GYN Physician needed: Nevada Health Centers is recruiting for a Board Certified OB for its Las Vegas Clinic. This is an opportunity to join an experienced team and to work with a supportive staff. We offer a competitive compensation package with full benefits. Email your CV to sharders@nvrhc.org.

House for sale by owner: Play tennis in your own tennis court in your backyard; 5500 sq ft home, 5 bd 7ba, 1/2 acre, gated SW, pool. Call 702-289-2835.

seeking internist or f.p.: to join a fully operational medical practice attached to St. Rose Siena hospital. Outstanding opportunity to take over a departing physician’s practice of over 2000 patients in a desirable location. Call (702) 614-0850 ext 108.

office space available: So Hills Area - Russell & Ft Apache time share or permanent space, new 3,000sf medical building. For information please call 939-1900.

Single family home for rent: in guard gated community. 4 bedrooms/3 ½ baths, large yard with pool and spa. Newly remodeled gourmet kitchen and fresh custom paint throughout. Partially furnished. Close to UMC and Valley Hospitals. $2900/mo. Available now. Call Ann @702-338-5335.

henderson office space: Beautiful office space to lease and share with established dermatology practice. Up to 7 fully furnished exam/procedure rooms available with nursing station and administrative space. Available now. For additional information, please contact Pamela Nesbet at 702-367-8458.

SEEKING BOARD CERTIFIED/ELIGIBLE MD OR DO: UNSOM's Family and Community Medicine in Las Vegas needs a FT family physician interested in Student Health. Must have Nevada license, eligible for malpractice. Apply online http://www.unrsearch.

OFFICE IN SOUTHWEST FOR LEASE: Rainbow-Quail Plaza, 5755 S Rainbow Blvd., 1609 sf. Rainbow frontage near 3 hospitals. Completely built out. Available immediately. Call 280-1003. RE/MAX One.

OFFICE FOR LEASE IN SOUTHWEST: Spanish Trail Business Park, near Spring Valley Hospital at Rainbow & Tropicana. 2500 sf available beginning January 2007. Building currently under construction. $1.50 NNN, TI allowance. Call 280-1003 or 222-0500. RE/MAX One.

Office space available: Desert Professional Plaza, 2225 E Flamingo Rd, 2 suites available - 1,200 sq ft and 1,100 sq ft can be combined for 2,300 sq ft. Completely built out - call 221-7000 for more information.

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CME CALENDAR

Bechtel Nevada 295-0208

NV Chapter AACE 434-8400

Pri-Med Institute (877) 4PRI-MED

Sierra Health Services 242-7735

Feb 8 - “HPV Vaccine Update”

Southern Nevada AHEC 318-8452

Southwest Medical Associates 242-7735

Summerlin Hospital 233-7572

Sunrise Hospital 731-8210

UMC 383-2604

Feb 9 - “The Re-Emergence of Syphilis”

Feb 14 - “The Clinical Evaluations & Treatment of ED Ischemic Stroke Patients: Thrombolysis & Beyond”

Feb 16 - “Smoking Cessation”

Feb 23 - “Coccidioidomycosis”

Valley Hospital 388-4847

Education Opportunities for Practice Managers, Call the NV Medical Group Management Association:

697-5471 ext 134

Only CME Activities held at the Clark County Medical Society office are specifically endorsed by CCMS.

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County Line Advertisers

Commercial Specialists…..364-0909

Comprehensive Cancer Centers of NV ……952-3400

Consultants in Marketing….944-2464

Ensemble Real Estate Services ….562-7595

Investment Equity Development....702-871-4545.... www.investmentequity.com

Lee & Associates…………739-6222….. www.LeeLasVegas.com

Medical Group Management Association ….. 697-5471 ext. 134

MxSecure, Inc …..888-580-1010 …. www.mxsecure.com

Nevada Docs Support Association, Inc …….. 215-4894 …… www.nvdocs.com

Nevada Mutual Insurance Company ….. 798-6001 ….. www.nevadamutual.com

Premier Physicians Insurance Company…..860-6130 ... www.ppicmedmal.com

Protrans ….. 877-6333 ….. www.protranslv.com

Schadler Kramer Group …933-3000…. www.skglasvegas.com

The Firm……. 739-9933

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