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1 No. 8 / August 2010 Information service for hospital radiologists and nuclear medicine specialists Law Management Economics Private liquidation Criminal law Chief radiologist arrested on suspicion of billing fraud: Where are the limits? from RA / FA for medical law Dr. Tilman Clausen, Schroeder-Printzen law firm, Hanover, at the beginning of June 2010 the Berlin police searched several hospitals in a large raid and arrested two managing directors as well as a chief radiologist. The investigation is based on allegations of incorrect or unnecessary medical treatment and falsified invoices. What is behind the suspicion of billing fraud? Where can chief physicians expose themselves to the accusation of fraud when billing private medical services to optional service patients? And how can you protect yourself against it? The following post provides answers to the questions. Violation of personal service provision In the core area of elective medical services, which is defined differently from specialist group to specialist group, the chief physician with the right to liquidate is obliged to provide the medical services personally if he wants to settle them for his private patients after the treatment has been completed. A representation of the chief physician in the core area of elective medical services is only possible within the limits defined by the Federal Court of Justice (BGH) (BGH, judgment of, Az: III ZR 144/07). Therefore, every head physician should always observe the following information: The patient must be informed as early as possible about a foreseeable prevention of the elective doctor. In this case, the offer must be made to him that a specific representative will provide the elective medical services in his place under the agreed conditions. The patient is to be informed about the alternative option to forego the use of elective medical services and content Employee management Targeted personnel development in the department Current case law Resident radiologists can sue for permission Collective bargaining law No TV doctors / VkA for chief physicians Quality assurance New quality criteria without additional payment from the to have the doctor on duty treated. If the respective measure can be postponed until the elective doctor is unable to attend, the patient must be given a choice. Outside the core area of elective medical services, 4 (2) sentence 3 GOÄ also applies. The medical services listed there, which include, for example, counseling and examination services or visits, can also be billed by the elective doctor if they were not provided by himself, but by his permanent medical representative, who must be a specialist in the same field. However, the case law assumes that in principle only one representative per elective doctor is permitted here (BGH, judgment of, Az: III ZR 144/07). Sanctions in the event of violations of personal service provision If chief physicians violate the above principles of personal service provision in the case of elective medical services and this becomes known, they must expect investigative proceedings on suspicion of billing fraud. These can also lead to charges being brought, especially if the violations have occurred over a longer period of time. Radiologist-CF-8-10.indd: 59:56
2 Billing by authorized chief physicians Also chief physicians who are authorized by the responsible association of statutory health insurance physicians to treat GKV patients are obliged to personally provide the medical services that they are allowed to provide and account for under this authorization. Violations of the principle of personal service provision within the framework of the authorization of the head physician (which often occur in practice) lead, on the one hand, to claims for reimbursement by the competent health insurance company with regard to the fee paid. In addition, they can also result in criminal investigations on suspicion of billing fraud. Potential conflicts with the hospital operator All violations by chief physicians of billing provisions, both in the area of GOÄ and in the area of authorization, also involve a further risk: If the relationship of trust between the chief physician and his hospital operator is already disrupted, the hospital operator can use these violations as an opportunity to terminate the employment relationship with the chief physician without notice. A conviction of the chief physician for billing fraud justifies termination of the chief physician's service contract without notice. However, it is also possible to terminate the chief physician's service contract without notice. Under certain circumstances, the initiation of a public prosecutor's investigation may be sufficient for this. Employee management Targeted personnel development in the department: Motivate employees for goals by Cornelia Harms-Schulze, CHS Personaltraining & -beratung, Bremen, How can chief physicians achieve effective leadership? What do the medical staff have to do in order to experience targeted personnel development? The following article uses an example to show what employees need in order to be able to develop individually and at the same time to become a team member. In addition, the chief physician is taught how to take his employees with him to his departmental goals. Example You are the chief physician in a radiology department and you have decided to take part in a series of seminars with your employees aimed at improving communication with patients. Already on the first day of the seminar it becomes clear: If you clearly formulate how you imagine the communication, the resistance of the employees increases because they constantly reply that this or that does not work because ... You will also understand why some of your employees provoke more patient complaints than others: Obviously, they do not have acceptable communication behavior, including with colleagues. The employees also have a problem with a patient or colleague and have the corresponding blame ready at hand. Therefore, it seems to you that they are unmotivated. Even criticism from colleagues or patients is obviously rejected before it has been examined. At the same time you notice that the employees handle things completely differently and that interdisciplinary agreements are apparently made completely arbitrarily. The problem analysis Actually, you only wanted to improve the communication behavior of your employees by imparting discussion rules. But after the seminar and the impressions mentioned above, one thing is certain: It's about more. Not only the interpersonal leaves a lot to be desired, the lack of structure within the department and lack of coordination with other departments make working together for the joint treatment task more difficult. You then carry out a problem analysis and develop a binding internal communication system for your department. The result: The communication and cooperation between your employees or colleagues from other areas and you is disturbed; this manifests itself in rejection, resistance, irritability and indiscipline. Employees lack information about the difficulties others are facing. Everyone has their own point of view. There are power games between those involved (colleagues, employees, patients) and mutual accusations. There is no shared decision-making. The consequences: motivation dwindles, resignation spreads and the feeling arises that nothing is changing. There is a lack of knowledge of conversation rules and strategies. There are different values. Radiologist-CF-8-10.indd: 59:57
3 Three building blocks for successful communication The analysis shows: The basis on which communication can take place first requires an organizational structure that regularly brings everyone involved to the table and gives them the opportunity to speak to one another in a constructive manner, i.e. solution-oriented and not blame. Analyzing complex situations, understanding and bringing different groups and employees together, and at the same time dealing constructively with conflicts, requires three components: Regular team meetings (also with representatives of other professional groups), annual employee reviews, regular discussions with other departments. 1. Regular team meetings Regular team meetings require a clear moderation structure, especially when it comes to dealing with disruptions in everyday work. It has to be worked out in a structured way, for whom there are which problems and what causes are behind them. Then it is important to develop ideas for a solution together, in order to then jointly decide which is the best for everyone involved. In no case should it be forgotten to set a joint date to check whether and what has been implemented and what, if necessary, needs to be improved. At the same time, it is necessary to find rules for dealing with conflicts. Essential points of orientation for this are: No defense, no counterattack or downplaying in order to promote the objectification of the conflict, questions about the background in order to understand the conflict partner, acceptance of the conflict, ask conflict partners for proposed solutions, develop alternative solutions, agree on a solution, agreements on Meet implementation, determine implementation control. All employees should be familiar with this methodology and it must be used by all in a binding manner. The manager is responsible for this. 2. Agree on goals and talk to employees Annual employee appraisals should, as a targeted and systematic form of personnel development, contribute to increasing performance in hospitals. You can motivate individual employees provided they are managed responsibly. This only works if the manager engages in a real dialogue, in which the questioning is the focus as a discussion strategy, shows systematics and consistency in the discussions, creates clarity about requirements and expectations, works out solutions together with the employee, information not as an instrument of power used, but made available to everyone. Reader service: You can find out what content should be in a target agreement and how the conversation can be conducted in the free guide to target agreement. Request this guide at. 3. Look for regular conversations with other departments. Specific perspectives and competencies, also from other professional groups, collide because they have to be assessed, planned, decided and acted together. Therefore, work processes have to be coordinated with one another and at the same time instruments have to be developed to shape cooperation. That is only possible together. Understanding the processes, employees and colleagues is a prerequisite for interdisciplinary cooperation in order to better meet the specific needs of patients. These conversations, too, must follow a certain structure if they are to be effective. An interdisciplinary team meeting tries to resume the discussion. The following structure of the conversation serves to support the discussion and the exchange of the different perspectives: Seeing = collecting information in an objective way Understanding = analyzing information, arranging it and bringing it into context Evaluating = relating interpreted information to values and goals Deciding = from the assessed situation draw the conclusions The manager decides on values in his department. The building blocks often set development processes in motion first. With the meeting or discussion structure and the approval of conflict resolution strategies, a chief physician makes it clear which values and principles should prevail in his department. Radiologist-CF-8-10.indd: 59:57
4 ARTIREM 0.0025 mmol / ml solution for injection in pre-filled syringes. Active ingredient: gadoteric acid. Composition: Active substance: 1 ml injection solution contains 1.397 mg gadoteric acid (as meglumine salt), corresponding to 0.0025 mmol gadoteric acid, meglumine with 0.39 mg gadolinium. 20 ml solution for injection contain 27.932 mg gadoteric acid (as meglumine salt), corresponding to 0.05 mmol gadoteric acid, meglumine with 7.86 mg gadolinium. Other ingredients: meglumine, water for injections, sodium chloride, sodium hydroxide (E 524) and hydrochloric acid (E 507) to adjust the ph value. Areas of application: Arthrography with magnetic resonance imaging (MRT) for the following joints and diseases: Shoulder: Diagnosis of partial ruptures of the rotator cuff, diagnosis of tears of the glenoid labrum and injuries to the labrum-biceps tendon complex; Hip: diagnosis of labral ruptures, free joint bodies and cartilage lesions; Elbow: diagnosis of ligament ruptures; Knee: Detection of residual or recurrent meniscal ruptures, diagnosis of free joint bodies, plicae synoviales and the stability of osteochondral defects; Wrist: assessment of ligaments and ulnocarpal complexes; Ankle: diagnosis of ligament damage, impingement syndrome and free joint bodies; general for all joints: detection of intra-articular osteochondral joint bodies. Contraindications: Hypersensitivity to gadoteric acid, meglumine or other drugs containing gadolinium. Contrast media containing iodine must not be used at the same time as ARTIREM, since the effectiveness of ARTIREM can be weakened if used at the same time (see instructions for handling in the product information). In the absence of clinical experience with children, ARTIREM must not be used in children and adolescents under 18 years of age. Side effects: In the joint examined, mild pain was reported frequently (1/100 to <1/10) and occasionally (1 / 1,000 to <1/100) joint discomfort. In rare cases (<1 / 10,000), anaphylactoid reactions have been reported, which, particularly in patients with a history of allergies, can very rarely be severe, life-threatening or fatal. Irrespective of the amount administered and the type of application, these allergic reactions can occur in the form of one or more of the following symptoms: angioedema, anaphylactic shock, cardiac and circulatory arrest, hypotension, laryngeal edema, bronchospasm, laryngospasm, pulmonary edema, dyspnoea, stridor, cough, Pruritus, rhinitis, sneezing, conjunctivitis, urticaria and rash. Some of these symptoms can be the first signs of the onset of anaphylactic shock. Delayed contrast agent reactions are possible. Interactions: No interactions with other medicinal products have been observed. No interaction studies have been performed. ARTIREM should not be mixed with other compounds. Note: Please note the current instructions for use and specialist information with further information. Prescription only. Guerbet, BP 57400, Roissy CdG Cedex, France. Local representative: Guerbet GmbH, Otto-Volger-Straße 11, Sulzbach, Germany. (As of April 2009) Radiologen-CF-8-10.indd: 59: 59
5 ARTIREM Gadoteric Acid THE MR contrast medium for direct MR arthrography Radiologists-CF-8-10.indd: 00: 00
6 Current jurisprudence Resident radiologists can appeal against permission from RA / FA for medical law Olaf Walter and RAin Anna Mündnich, WIENKE & BECKER - COLOGNE Interesting news for hospital doctors: registered contract physicians can also apply against an official permit, the hospitals to participate in the outpatient medical care. The Saxon State Social Court recently came to this conclusion (decision of, Az: L 1 KR 94/10 B ER). The court thus confirmed the first-instance urgent decision of the Dresden Social Court, which had already been issued in this regard. According to this, contract doctors are entitled to take action against the provision of a hospital for outpatient patient care in accordance with 116b of the Social Code (SGB) V. In addition, the court decided in the urgent proceedings that the action had suspensive effect, so that the clinic was not allowed to provide outpatient services according to 116b SGB V until a final court decision was reached. Conclusion: The decision is a success for the registered contract doctors. However, since the court does not require a needs test for the determination of a hospital for outpatient patient care, but only an insignificant impairment of the contract doctor situation, the requirements for the hospital determination to justify an improvement in the care situation of the patients are not high. Collective bargaining command back! No TV doctors / VkA for chief physicians from RA Norbert H. Müller, Klostermann office, Dr. Schmidt, Monstadt, Dr. Eisbrecher, Bochum Since the BAT was discontinued at the end of 2005 and two follow-up collective agreements came into force in mid-2006 TVöD and TV-Ärzte / VkA, the question arose as to whether the chief physicians previously remunerated individually according to BAT I as well as the subordinate medical staff according to the TV-Ärzte / VkA are to be remunerated, receive permanent static remuneration according to BAT or can claim dynamization according to TVöD. On 9June 2010, the Federal Labor Court (BAG) decided this question for various case constellations: In all cases, the BAG rejected a claim of the chief physicians for remuneration according to the TV doctors / VkA. However, the court sees an entitlement to dynamic remuneration. Without knowing the exact reasons for the judgment, questions still remain open. We will report again as soon as the reasons for the judgment are available. What happens with the BAT-KF? At the present time, the arguments of the BAG cannot be transferred to the similar problems of the federal employee collective agreement in the church version (BAT-KF). There are no traditional two follow-up collective agreements, but the old BAT-KF is followed by the new BAT-KF, which then expressly declares the TV-Ärzte-KF to be applicable within the new BAT-KF with regard to the remuneration for doctors. If the contract refers to remuneration according to BAT-KF and the supplementary or replacing regulation, you will certainly come to the new BAT-KF, which then only refers to the TV-Ärzte-KF in terms of content for doctors' remuneration. The BAG has not yet made a decision on these cases. The first and second instance judgments had all decided in favor of the chief physicians. Quality assurance New quality criteria On June 17, 2010, the G-BA decided on new quality criteria for radiological examinations. Probably the most important change due to the new radiology quality assessment guideline is that it standardizes the requirements for image quality for examinations by the KVen and further examinations by the medical authorities. For this purpose, the medical quality requirements of the updated guidelines of the German Medical Association for quality assurance in X-ray diagnostics and computed tomography have been incorporated into the guideline. The new directive is due to come into force this summer. Imprint Editor: Publisher: Editor: Delivery: Note: Guerbet GmbH, Otto-Volger-Straße 11, Sulzbach / Taunus, Tel, IWW Institute for Economic Journalism, Publishing House Tax Law Wirtschaft GmbH & Co. KG, Aspastraße 24, Nordkirchen, Telephone, Fax RAin Heike Mareck (responsible); RAin, FAin StR Franziska David (Editor-in-Chief) This information service is a free service from Guerbet GmbH. The content of the Contrast Forum has been created to the best of our knowledge and state of knowledge. However, the complexity and constant change of the legal matter dealt with in it make it necessary to exclude liability and guarantee. The Contrast Forum does not always reflect the opinion of Guerbet GmbH. Radiologist-CF-8-10.indd: 00: 00
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