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Further Implications of the U.S. Patriot Act for Hospitals

By Dr. David E. Marcinko; MBA, CMP™

By Hope R. Hetico; RN, MHA, CMP™dave-and-hope4

With the recent popularity and growth of health savings accounts (HSAs) and / or medical savings accounts (MSAs), compliance with the USA Patriot Act of 2002 has become an important issue for these new, hybrid health insurance products.

Many of these insurance plans place patients and insurers into relationships with shared information institutions like hospitals, healthcare organizations, medical clinics and patient clients.

The “Online” Connection

This occurs because many, perhaps even the majority of HSAs, MSAs and high deductible healthcare plans [HD-HCPs] are opened online, as patients and insurance company clients use Internet search engines to find the “best” policy type to meet their needs. 

Ditto, for more traditional health insurance plans, as well? 


For example, on October 1, 2003, Section 326 (Customer Identification Program) of the US Patriot Act went fully into effect, requiring the implementation of reasonable procedures to verify the identity of new customers and certain existing customers opening a new MSA or HSA account. 

And, Section 3261 of the Act also requires banks, savings associations, insurance companies, hospital and medical union credit unions, and certain non-federally regulated banks to have the CIP fully implemented. Broker-Dealers [BDs] in securities are subject to similar, but slightly different rules.   

Bank Secrecy Act [BSA] 

For additional compliance, The USA Patriot Act also amended the Bank Secrecy Act (BSA) to give the federal government enhanced authority to identify, deter and punish money laundering and terrorist financing activities.

Increased Hospital Vigilance

This, the passage of the USA Patriot Act – and these important derivatives – means that affected hospitals and healthcare organizations must be more vigilant about laws concerning money laundering; reporting of disease and quarantine; and cyber attacks.

Moreover, it means that healthcare organizations must adhere to the Act, regarding affected health insurance policies, by meeting its Customer Identification Program (CIP) and anti-money laundering requirements.  


Whatever the financial outlays required for compliance – there be very large savings later if affected hospital assets and patient health insurance information is safeguarded against attacks of virtual or real assets. 


And so, what is your opinion on the above health law and policy? 

Related source:Marc B. Royo and David B. Nash.Sarbanes-Oxley and Not-for-Profit Hospitals: Current Issues and Future.”

Speaker: If you need a moderator or a speaker for an upcoming event, Dr. David Edward Marcinko; MBA is available for speaking engagements. Contact him at: MarcinkoAdvisors@msn.com

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Charitable Giving Terms and Definitions for Physicians

A “Need to Know” Glossary for all Medical Professionals

Staff Writer’sdhimc-book

For most medial professional’s, charitable giving can either be a financial planning goal or an economic tool to achieve other goals more effectively.   

When charitable giving is viewed as a financial goal it becomes a very personal matter to the physician, much like an individual’s other lifestyle choices. 

For some doctors, charitable giving is a way of showing gratitude for their well-being. For others, it is a matter of social status. Still some physicians approach charitable giving as a discipline of their religious or philosophical view of life.  

Nevertheless, various charitable giving techniques are available to meet a physician’s unique financial planning requirements. These techniques generally fall into two broad categories: current gifts and planned or deferred gifts.  

Current gifts are rather simple techniques that can be completed at or near the current moment.

Planned or deferred gifts are generally complicated transactions that are to be completed in the future. 

Use of a particular charitable giving technique will depend largely on the doctor’s capacity to understand and evaluate complex alternatives – strength of donative intent – as well as his/her current and future cash flow needs, types of assets owned, strength of charitable intent, and income and estate tax considerations.

Glossary of Terms

5% probability rule: In general, charitable income tax deductions are disallowed when there is greater than a 5% chance that a noncharitable beneficiary will live long enough to exhaust the charity’s remainder interest. Charitable remainder unitrusts are exempt from this rule [Rev. Rul. 77-374]. 

Bargain sale: A sale of property to a charity for less than the property’s fair market value [Regs. §1.1011.2].

Charitable gift annuity: An arrangement under which a donor makes a gift to a charity in exchange for systematic payments of income for a period of time [Regs. §1.170A-1(d)]. 

Charitable income trust: A trust created by a donor doctor that provides for income payments to a charity for a period of time, after which the remainder is paid to a non-charitable beneficiary. Payments to the charity are limited to the amount of income earned by the trust [Rev. Rul. 79-223]. 

Charitable lead trust: A trust created by a donor that provides for payments to a charity for a period of time, after which the remainder is paid to a non-charitable beneficiary. Payments to the charity are either a fixed amount annually or a fixed percentage of the value of assets in the trust at the beginning of each year. Payments are not limited to the amount of income earned by the trust [IRC §664(a)]. 

Charitable remainder trust: A trust created by a physician-donor that provides for payments to a non-charitable beneficiary for a period of time, after which the remainder is paid to a charity. Payments to the non-charitable beneficiary are a fixed amount annually. Payments are not limited to the amount of income earned by the trust [IRC §664(a)].

Charitable remainder annuity trust (CRAT): A trust created by a physician-donor that provides for payments to a non-charitable beneficiary for a period of time, after which the remainder is paid to a charity. Payments to the non-charitable beneficiary are a fixed amount annually. Payments are not limited to the amount of income earned by the trust [IRC §664(d)(1)].

Charitable remainder unitrust (CRUT): A trust created by a physician-donor that provides for payments to a non-charitable beneficiary for a period of time, after which the remainder is paid to a charity. Payments to the non-charitable beneficiary are a fixed percentage of the value of assets in the trust at either the beginning or the end of each year, depending on the trust agreement. Payments are not limited to the amount of income earned by the trust [IRC §664(d)(2)].

Donative intent: The inclination of a physician-donor to make a gratuitous gift to charity.

Income in respect of a decedent: Amount due and payable to a decedent at his or her death because of some right to income. Examples of income in respect of a decedent include salaries, retirement benefits, annuity payments, interest, dividends, rents, and deferred gain on an installment contract, earned but not received by the decedent before his or her death [IRC §691(c)(2)].

Insubstantial rights: Rights to the use of donated property that is retained by a physician-donor when the retained rights do not interfere with the donee-charity’s unrestricted use or full ownership of the donated property [George v. U.S. 11/30/61, DC-MI]. 

Pooled income fund: A fund that commingles property gifted by several donors, where each donor designates a non-charitable person to receive income for life and a charity to receive the remainder interest [Regs. §1.642(c)-5].

Private foundation: A tax-exempt organization under IRC §501(c)(3) that does not enjoy a broad base of public support [IRC §§508, 509].

Public Charity: A tax-exempt organization under IRC §501(c)(3) that enjoys a broad base of public support [IRC §509(a)(2)].

Qualified appreciated stock: Stock for which a market price quotation is readily available and that would generate a capital gain if sold [IRC §170(e)(5)].

Qualified charity: An organization described in IRC §170(c). Gifts to these organizations can be deducted by donors for income, gift, or estate tax purposes. 

Qualified conservation contributions: A restriction on the use of real property, a remainder interest in real property, or a physician-donor’s entire interest in real property that is given to a qualified charity for conservation purposes [IRC §170(f)(3)(A)].

Quid pro quo: The expectation by a physician-donor that he or she will receive a bargained-for benefit in exchange for a gift to a charity [Rev. Rul. 76-185].

Reduction rules: Exceptions to the general rule that gifts to charity are deductible to the extent of the fair market value of the donated property [IRC §170(e)(1)(A)].

Supporting Organizations: A tax-exempt entity that is established by an individual or small group of donors for the purpose of supporting a public charity.

Remainder interests: Property rights that can be enjoyed only after prior rights have terminated. 

Undivided interests: Rights that joint owners share in the entirety of a property as opposed to rights they enjoy to segregated pieces of a property. 

For related information: www.HealthDictionarySeries.com 

Additional info: http://www.jbpub.com/catalog/0763745790/

Note: Feel free to send in your own related terms and definitions so that this section may be updated continually in modern Wiki-like fashion.

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Using Fraud Detection Software to Review Medical Claims

MDs May be Slow HIT Adopters – CMS and Insurers are Not!

Staff WritersShadows

Did you know that Medicare and private health plans increasingly have been “mining” medical claims data for potential fraud – for some time now – and with the help of sophisticated computer technology? 

Yes, it seems true – and such IT may be needed more than ever in 2008!

How Much Fraud? 

Fraud accounts for an estimated 3% to 10% of the $2 trillion spent annually on healthcare in the U.S. Within the past few years, companies including Fair Isaac, IBM, ViPS and Ingenix, a subsidiary of UnitedHealth Group, have developed software that detects suspicious patterns in claims data.  

“Spider-Web” Technology

According to the CMS, their technique is called “spider-webbing. 

IOW: Find one common denominator and follow the thread. 

“Red flags” indicating possible fraud include medical providers charging more than peers; providers who administer more tests or procedures per patient than peers; providers who conduct medically “unlikely” procedures; providers who bill for more expensive procedures and equipment when there are cheaper options; and patients who travel long distances for treatment. 

Private Insurers to Follow CMS

For example, Aetna reported its fraud-detection software helped the insurer prevent more than $89 million in fraudulent reimbursements from being paid last year, compared with $15 million it was able to recover after fraudulent payments were already made.

Companies are able to save far more money by detecting fraud before claims are paid than recovering the money after the fact. 


And so, what are your thoughts on this HIT initiative? Are the private insurance companies and CMS taking advantage of the slow HIT adoption of medical providers? Who is to blame, if anyone? 

Please comment: 

More info: www.HealthcareFinancials.com

Related info: http://www.jbpub.com/catalog/9780763733421/ 

Original source: USA Today 11/07/06

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Medical Malpractice Claim Causation Study

Physician Errors Do Play a Role — A.I.M.

 By  Staff Writers

 According to a two-year old report in the Annals of Internal Medicine, physician errors are a factor in about 60% of medical malpractice claims that involved patients allegedly injured because of missed or delayed diagnoses. 

The B&WH Study 

For the study, researchers at Brigham and Women’s Hospital in Boston reviewed 307 claims from four large malpractice insurers that were closed between 1984 and 2004. 

181 of the claims involved diagnostic errors that allegedly injured patients; and ignored the outcomes of the claims.

Although most of the claims involved several factors, the major ones involved physician errors. 

The Results 

According to the study:

  • 100 claims involved failure to order appropriate diagnostic tests; 
  • 81 claims involved failure to establish a plan for appropriate follow-up care;  
  • 76 claims involved failure to obtain an adequate H&P or PE; 
  • 67 claims involved improper interpretation of diagnostic tests.  


Contributing Factors 

The main factors that contributed to the physician errors included failures in judgment (79%), memory problems (59%), lack of knowledge (48%), patient-related issues (46%) and patient handoffs from other physicians (20%).


And so, how does this impact your thoughts on the topic; please comment? 

 More information: http://www.jbpub.com/catalog/9780763733421/

Cash Flow Terms and Budgeting Definitions

A “Need to Know” Glossary for all Medical Professionals

Staff Writers 

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Regardless of how much current income a physician may earn, financial resources and assets are only useful when they are converted to cash. Doctors who are in the accumulation phase of their careers can only amass new assets from free cash flow.

Free cash flow is the result of budgeting for excess cash flow and the prudent use of debt. And, debt can be either a friend or foe!  

If used properly, debt can increase a medical professional’s standard of living by allowing him or her to enjoy an asset or goal earlier than if he or she had to pay cash.  Or, it may be a catastrophe as seen in the recent housing market value-decline and security backed mortgage-bubble bust.   

Yet, debt management has become a serious issue in American society, especially for non-secured debt because of easy access to credit via credit cards. And, it is not unusual to hear the story of a medical professional with $100,000 of credit card debt; or more.  Although perhaps an extreme example, it is not unusual for doctor’s to have $15,000 to $25,000 of revolving credit card debt.  

Glossary of Terms 

Adjustable rate mortgage: A mortgage loan that has an interest rate that changes in response to market interest rates during the loan’s term. 

Cash reserve: The amount of assets that are quickly convertible into cash for the purpose of meeting un-foreseen expenditures or reductions in income. 

Closing costs: Expenses that accompany the buying, selling, or financing of real estate. 

Consumer Price Index: A statistic published by the Bureau of Labor Statistics for the purpose of reporting the average consumer inflation rate. 

Debt consolidation: A debt management strategy that involves borrowing money in a single loan to repay other debts. 

Deferred expenses: Expenditures that are planned to occur several years in the future, usually requiring large outlays of cash. Examples include paying for college expenses, buying a vacation home, and paying for a child’s wedding. 

Discount points: Payments made to a lender at the inception of a loan for the purpose of reducing the interest rate of a loan.

Federal Deposit Insurance Corporation: An agency of the United States government that insures deposits in federally and state-chartered banks. 

Federal Depository Insurance: A program of the Federal Deposit Insurance Corporation that insures depositors in federally and state-chartered banks. 

Fixed rate mortgage: A mortgage loan that has a constant interest rate for its whole term.

Home equity loan: A mortgage loan, usually in addition to the primary mortgage loan, which allows the borrower to convert a portion of real estate equity into cash. 

Loan origination fee: Payments made to a lender at the inception of a loan to pay for the lender’s underwriting services.

Money market deposit account: An account offered at a banking institution that has features similar to a money market mutual fund. Accounts under $100,000 are insured by the Federal Deposit Insurance Corporation. 

Money market mutual fund: A registered investment company that invests in securities that have short-term maturities (usually from several days to several weeks). 

Mortgage broker: An intermediary who charges a fee to facilitate acquisition of a loan to purchase real estate. 

Mortgage insurance: A coverage that is often required by lenders, and paid for by borrowers, for the purpose of insuring the lender against potential default by the borrower. 

National Credit Union Administration: An agency of the United States government that insures deposits in credit unions. 

National Credit Union Share Insurance Fund: A program of the National Credit Union Administration that insures shareholders of credit unions. 

Non-recurring expenses: Irregular household operating expenditures, the timing of which during a year may not be determined precisely, or expenditures that occur less frequently than monthly. Examples include car repairs, home repairs, and insurance premiums. 

Personal Inflation Index: A statistic that adjusts the Consumer Price Index to specific spending patterns of a household. 

Recurring expenses: Regular household operating expenditures that occur every month. 

Reverse mortgage: A loan secured by real estate that allows the borrower to convert equity into cash without having to make monthly payments during the term of the loan. The loan plus accrued interest is paid from the proceeds of the sale of the property.

Savings Association Insurance Fund: A program of the Federal Deposit Insurance Corporation that insures depositors in federally chartered savings institutions.

Securities Investor Protection Corporation: A membership corporation of securities firms that was authorized by the Securities Investor Protection Act of 1970. 

Total Annual Loan Cost: The total annual financing costs associated with a reverse mortgage.

For more information: www.HealthDictionarySeries.com 

Note: Feel free to send in your own related terms and definitions so that this section may be updated continually in modern Wiki-like fashion.

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“First Do No Harm” – A Medical Legal Imperative

Primum Non Nocere

By Dr. Jay S. Grife; JD, MA

This Latin phrase is axiomatic in intent and is one of the earliest inoculations students of medicine receive.  It dovetails the Hippocratic Oath to provide both a moral and ethical foundation for physicians in furtherance of their mission to heal the sick. It asks little in objective terms but demands an immense measure of dedication and knowledge from those who practice their profession.  Yet, it is roughly estimated that one of every five practicing health care professionals will confront the enigmatic process of medical malpractice within a twelve-month span. Despite the fact that most health care practitioners will never see the inside of a courtroom, the sequelae of the event itself can scar the psyche forever after. And so, the quintessential risk-management question for all medical practitioners is: What can be done when the inevitable happens and what can you as a practicing doctor do to confront the process? 

-Dr. David Edward Marcinko; MBA, CMP™



“Even among the sciences, [and in the managed care era], medicine still occupies a special position. Its practitioners come into direct and intimate contact with people in their daily lives; they are present at the critical transitional moments of existence. 

For many people, they are the only contact with a world that otherwise stands at a forbidding distance.  Often in pain, fearful of death, the sick have a special thirst for reassurance and vulnerability to belief.” 

Socialization of Medicine and the Litigation Prescriptive “Spark”  

When this trust is violated, whether rooted in factual substance or merely a conclusion lacking in reality, American jurisprudence offers several remedies with the core being civil litigation.

For example, I have witnessed a vast spectrum of reasons that prompts a patient to seek the counsel of an attorney.

Whether it be an untoward result of treatment or surgery, an outstanding invoice being mailed to a less than happy patient who decides that the doctor’s treatment did not measure up to expectations, a physician’s wife, employed as the office manager, charging a patient eighty-five dollars to complete a medical leave authorization form, or simply a perceived lack of concern on the part of the doctor or his personnel, patients can be motivated to seek redress outside the realm of the doctor’s office. 

Compound any of the above scenarios with well-meaning friends and family, and the proverbial initiating “spark” has been lit; and the prescription for litigation has been written.

Bilateral Communication is a Preventative Key 

Woven throughout any discussion of the topic, should be suggestions that might obviate the foregoing.

While it is not a panacea, nor a cure-all for medical negligence cases, many believe it to be the most effective methodology for resolving those differences that see the growth of a medical malpractice lawsuit; honest and bilateral communications. 

Not Trial Bound by Destiny 

In the United States, a trial is thought to be the most common manner in which disputes are resolved. Contrary to what we see on television, very few cases actually make it to trial with most be either dismissed or resolved through mediation or arbitration.

In fact, a few years ago the U.S. Department of Justice recently reported that only about three percent of all civil cases are resolved by a trial. The vast majority of civil lawsuits, and in particular medical malpractice cases, are settled or dismissed before any of the litigants see a courtroom. 

MORE: http://shrutinshetty.com/2016/10/27/primum-non-nocere/


What has been your experience on this often contentious topic – settle or litigate – please comment? 

Reference: [1] Paul Starr: The Social Transformation of American Medicine, Basic Books, 1982, pgs. 4-5.

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