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The “Address Discrepancy Rules” and Medical Compliance Rules
[By Staff Reporters]
Healthcare executives and CFOs are looking for help to better understand and comply with the Red Flag and Address Discrepancy Rules from the Federal Trade Commission (FTC). The Rules were issued to curb identity theft in the United States, and require companies including most hospitals, to submit their written program to identify and manage ‘red flag’ accounts – originally – by November 1, 2008.
Core Elements
The core elements of the Red Flag Rules are identification, detection and response to patterns, practices, or specific activities – known as “red flags”. They include the two key issues.
1. Identification/Detection:
Inconsistencies of addresses constitute a ‘red flag’ to the registrar and organization.
2. Response:
When a ‘red flag’ is found, predetermined workflows within workflow solutions guide the registration process and financial relationship with patients, including those identified as a red flag patient, using validated patient information.
FTC Grants a Delay
However, the Federal Trade Commission just suspended enforcement of the new “Red Flags Rule” until May 1, 2009, to give creditors and financial institutions additional time in which to develop and implement written identity theft prevention programs. This recent announcement, and the release of an Enforcement Policy Statement, does not affect other federal agencies’ enforcement of the original November 1, 2008 deadline for institutions subject to their oversight to be in compliance.
Assessment
info: FTC Media Contact: Office of Public Affairs [202-326-2180]
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Filed under: Health Law & Policy, Practice Management, Risk Management | Tagged: red flags |
The Leading Business Education Network for Doctors, Financial Advisors and Health Industry Consultants 
New Report
Here is a great report or red flag rules; from the FTC.
The “Red Flags” Rule: What Health Care Providers Need to Know About Complying with New Requirements for Fighting Identity Theft
Link: http://www.ftc.gov/bcp/edu/pubs/articles/art11.shtm
George
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More than Just for Dentists
If you’re a covered entity undery the Red Flag Rules, your program must:
1. Identify the kinds of red flags that are relevant to your medical, dental, podiatric, optometric, chiropractic, or osteopathic practice, etc;
2. Explain your process and throughputs for detecting them;
3. Describe how you’ll respond to breaches and red flags to prevent and mitigate identity theft;
4. Mandate out how you’ll keep your program current, and;
5. Document the above.
Remember, on November 1, 2009 all physician practices must have written guidelines and procedures in place within their practice or they will be in direct violation of the FTC’s Red Flag Rule and could be subject to various fines and penalties.
Linda
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Thanks, Linda.
As a dentist, I would like to offer that I’ve given the Red Flags Rule a couple of minutes of proper consideration long before the successful 4th Quarter ‘09 Delay in implementation. I was actually one of very few dentists in the nation who was prepared for Red Flags before the celebration of the first 4Q Delay ’08.
In addition to reciting my entire office policy with each one of my 5 employees, here is what I posted for all to see, in English and Spanish.
“Attention employees: This is my HIPAA and Red Flags Rule Policy. Please read carefully”
HIPAA (HHS) – No records are to leave this office at any time, no exceptions. I will properly dispose of all records.
Red Flags Rule (FTC) – If anything looks suspicious concerning patients and financial matters, report it to me immediately.”
That’s it. Believe it or not, proper compliance hardly costs a thing if one does not have eHRs. This means cash-poor, good people in my neighborhood are more likely to afford the cost of the care that I provide since it does not include non-productive mandated busywork. Isn’t that important?
I wouldn’t be covered by the Red Flags Rule at all except that occasionally, I’m left with the choice of either waiting for full payment from someone in pain or turning them away. As far as waiting on insurance to decide if and when they are going to pay the remainder of their clients’ dental bills, I intend to stop accepting assignment just as soon as I can afford to do so. Insurance busywork always increases the cost of dental care.
Sorry, I strayed a bit.
If the Red Flags Rule is ever enforced, it will signal the end for most dental benefits companies, which are already struggling (I assume). When the FTC shows Congress that it means business in healthcare, lots of dentists will simply stop doing patients the favor of extending credit by accepting, waiting on and then fighting for reimbursement. Once dentists discover that the air is fine out here and the FTC isn’t, dental consultants working on commission for insurance companies will no longer be capable of holding payment hostage to increase profits and stock price. That’s what I think.
D. Kellus Pruitt; DDS
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Darrell,
Sorry, but the red-flag rules have again been delayed until June 1, 2010.
http://www.ftc.gov/opa/2009/10/redflags.shtm
The FTC – what a joke!
Linda
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Actually, Linda, I think there are some documentation requirements that go along with the Red Flags Rule that healthcare providers are still liable for.
I could be wrong.
D. Kellus Pruitt; DDS
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FTC Delays Red Flags Rule
On May 28th, the Federal Trade Commission announced it would delay enforcement of the Red Flags Rule from June 1st to Dec. 31, 2010. The commission cited Congressional consideration of legislation that would affect the scope of entities covered by the rule to require businesses to take specific steps to minimize identity theft. For instance, S. 3416, introduced on May 25 in the Senate, would exempt healthcare practices with 20 or fewer employees, as well as accounting and legal practices of similar size.
Covered healthcare professionals under the bill include physicians, dentists, podiatrists, chiropractors, physical therapists, occupational therapists, marriage or family therapists, optometrists, speech therapists, language therapists, hearing therapists, and veterinarians.
Source: Health Data Management [5/28/10]
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FTC grants Red Flags extension after medical groups file suit
After more than two years of appealing to the Federal Trade Commission that physicians shouldn’t be considered creditors under its “red flags rule,” on May 21st, the American Medical Association, the American Osteopathic Association and the Medical Society of the District of Columbia filed a lawsuit in federal court to fight for exemption to the federal regulation.
http://www.healthleadersmedia.com/content/PHY-251367/Lawsuit-Red-Flags-Rule-Violates-DoctorPatient-Relationship%20##
When will this fiasco ever be over?
Janice
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The FTC’s involvement in HIPAA compliance is not going to make your life easier, Doc
“Entities covered under the Health Insurance Portability and Accountability Act also may be subject to security enforcement by the Federal Trade Commission, the latter confirmed with a unanimous ruling against a medical testing laboratory that mishandled patient information.”
http://www.fiercehealthit.com/story/ftc-rules-hipaa-not-barrier-security-enforcement/2014-01-28?utm_medium=nl&utm_source=internal
DK Pruitt
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