Author Archives: michiganhealth

Conquering ADD In Children The Natural Way

2016-05-17_2104With the way alot of the laws have changed in the past few years, its a good idea to look into alternative ways of natural health if you dont have good health insurance. Especially if you have small children with ADD, a great alternative to this is a natural supplement the below article with give you and idea of what you can do.

Attention deficit disorder in children is becoming more common over the years. Initially, parents of children with ADD thought they were to blame for their children’s lack of ability to focus. For some reason, they assumed it had something to do with their parenting methods.

Recent research, however, has already proven this belief to be entirely false. ADD is actually caused by the lack of certain chemicals in the brain.

There are prescription medications that can be used to treat this disorder but many parents today are leaning more towards natural remedies for ADD/ADHD such as listol for children.

According to surveys, natural remedies for ADD are generally preferred due to several reasons, the most common of which is that these natural treatments are usually much safer than their artificial counterparts. In other words, they can be given to children without having to worry about possible negative side effects.

Finding remedies that can assist is easy now with the use of the internet. Although they do work differently, practically all of these natural remedies for ADD will help your child concentrate on his tasks and show better social behavior.
Other Natural Remedies For ADD In Children

Diet – If you are not yet ready to give your child any medication, whether natural or artificial, you can still help him conquer his disorder by giving him other natural remedies for ADD. For example, you can improve his diet by not serving him too much processed foods, as well as foods that have high amounts of salt and fat. Particularly sweet foods, like chocolate and candies, should be minimized as well. Instead, encourage him to eat more fresh fruits and vegetables — these will not only help eliminate ADD but will also considerably improve his overall wellbeing.

Exercise – Regular exercise is also one of the most effective natural remedies for ADD. In fact, many experts speculate that the reason why there are so many cases of ADD in children today is because children spend more time playing video-games and watching TV rather than playing outdoors and getting the exercise they need.

You can help your child beat ADD by encouraging him to participate in sports event in school, or by simply spending more time playing outdoors. Once your child gets regular exercise, he will be able to focus more on the important tasks, and also become much healthier and happier.

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PhRMA Makes Additional Drug and Patient Safety Information Available on Its Web Site

painkillers_0In an effort to better inform the public about drug and patient safety information, PhRMA has launched new web site pages.   In its press release about the new web pages, PhRMA states as follows:

  • Patient safety is our highest priority. We need a strong and effective FDA with the resources and personnel necessary to ensure the safety of the U.S. drug supply and continued access to innovative medicines.
  • Patient welfare should be at the center of any effort to enhance drug safety and ensure that benefit and risk are balanced.
  • Drug safety and effectiveness monitoring must be comprehensive and continuous. PhRMA supports efforts that seek to continually improve these activities.
  • Patients and health care providers must have accurate, timely, and useful information on which to base their decisions.

However if your looking for all natural supplements in order avoid the costly side effects, you search out other alternatives. If your having problems your thyroid, you can search for thyax reviews online to see how this supplement performs. And if its something you can use.

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State by State Prescription Drug Legislation

prescription+medicineAs many of my readers know, particularly including those who are lawyers, tracking pending legislation affecting the pharmaceutical and medical device industries on both a state by state and federal basis can be an especially daunting task.  Obviously, these industries are highly regulated, and as each new issue presents itself, the federal and state legislatures do what they do best:  legislate some more!  The result is a highly complex, almost rainbow-like color scheme of regulations that are often inconsistent, contradictory and sometimes, well, nonsensical (my apologies in advance to the decision makers).

With the help of Matthew Samsa, a summer associate at Benesch, I have located a fabulous tracking source that I can’t help but share.  I’d suggest that you check out the 2007 Prescription Drug State Legislation tracker, hosted by the National Conference of State Legislatures, which is the “Forum of America’s Ideas.”  So, for example, what does Colorado have to say about pedigree legislation?  According to the site, legislation was just passed that “[w]ould regulate prescription drug wholesalers; including requiring criminal history background checks of applicant representatives, updating requirement for maintaining and retaining “pedigree” records to prevent or diversion to unauthorized buyers.” The site further mentions the following status information:  “Filed 3/6/07; passed Senate 4/2/07; passed House 4/12/07; amended and sent to governor 5/15/07.”

Of course, I can’t make any representations or warranties about the accuracy of the content and how often the site is updated (if only I could write without including a disclaimer).  I can say, however, that this site may make tracking state legislation affecting the pharmaceutical industry a far more manageable task.

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On Site Drug Testing Are You In Compliance?

health care complianceDoes your organization have a culture of compliance? What are your compliance standards, policies, and procedures?  Who oversees your compliance program? How is compliance education and training conducted?  How do you monitor for compliance irregularities and how often do you conduct audits?  How does an employee report a compliance issue and how is the investigation handled?  What is your response to a compliance issue.  How do you prevent it from happening again?

Say for instant, you want to know about onsite drug testing, because believe me, there are potential employees, who search for how long does methadone stay in your system for a drug test. You want to make sure your company is in compliance.

Drug and Alcohol testing has become a mainstay in Corporate America. This is due in part to the effect that drugs and alcohol have on an employee’s safety, productivity, and quality of work. Let us bring the test site to your door so you no longer have to worry about delays in the workforce.

offers drug and alcohol on-site testing services to corporations, small businesses, education facilities, law enforcement, and everyday individuals. We offer pre-employment, post accident, return to work and follow-ups, reasonable suspicion, random drug and alcohol testing and hair analysis services.

So check with your local and state rep, to make sure your in compliance.

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New Rule Allows for Electronic Transmission of Controlled Substance Prescriptions

Controlled Substance PrescriptionsA new Drug Enforcement Agency (DEA) rule could substantially impact the way prescriptions for controlled substances can be transmitted from a physician to a pharmacy.

As physicians and pharmacies seek to cut costs and maximize efficiency, electronic record keeping and prescription filing has become more commonplace.

In response, the DEA has relaxed previous restrictions on electronically filing controlled substance prescriptions. However, recognizing the high risks posed by abusing or forging controlled substance prescriptions, the DEA has created a system of requirements which must be met before a physician is able to take advantage of the new rule.

The DEA defines controlled substances as drugs and other substances that have a potential for abuse and psychological and physical dependence; these include opioids, stimulants, depressants, hallucinogens, anabolic steroids, and drugs that are immediate precursors of these classes of substances.

Once classified as a controlled substance, drugs are then broken down into one of five categories depending on the potential for abuse and risk of dependance. Today, controlled substances account for between 11% and 12% of prescriptions written in the United States.

Under the previous rule, physicians were prohibited from electronically sending prescriptions for schedule II-V controlled substances to pharmacies. However, under the current rule, which was published March 31, 2010 in the Federal Register, physicians who meet certain requirements will be permitted to e-file those prescriptions beginning June 1, 2010.

To be eligible to e-file controlled substance prescriptions, physicians must meet two of three factors. The “two-factor authentication protocol,” which seek to guard against fraudulent prescription filings by confirming the prescribers true identity includes:

  • A password or PIN number
  • biometric data- either a fingerprint or iris scan, or
  • a “hard token”- a secured device separate from a computer that can provide a password to a physician at the time of e-filing.

To be eligible to e-file controlled substance prescriptions, physicians must validate their identity with a designated agency. When applying for the proper credentials to utilize e-filing programs, physicians must supply verifiable information such as government issued identification or financial account information.

Currently, Michigan laws vaguely address the current state of e-filing prescriptions for controlled substances. MCL 333.7333(7) states that physicians may electronically transmit prescriptions as long as they do not conflict with federal law.

The law does not differentiate between controlled substance and non-controlled substance prescriptions. As a result, we may see future clarification from the Michigan legislature or the Board of Pharmacy regarding this issue.

Importantly, physicians and pharmacies that currently possess the technology to e-file prescriptions must ensure that their systems comply with the new DEA “two-factor authentication protocol” requirements for controlled substances.

Licensed physicians who cannot afford to implement the required technology or simply wish to opt out of the program are still able to produce physical prescriptions which can be presented at a pharmacy.


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Medical Residents Considered Employees, Not Students, Under Federal Tax Law

Medical Residents Considered Employees, Not Students, Under Federal Tax LawOn January 11, 2011, the United States Supreme Court, in an unanimous opinion authored by Chief Justice Roberts, upheld a Treasury Department rule that established that medical residents are full-time employees, not students, for purposes of federal income taxation and Social Security coverage.

The case considered a federal law, namely the Federal Insurance Contributions Act (FICA), which exempts students from paying Social Security taxes. In 2004, the Treasury Department issued a rule that essentially stated medical residents were not students and therefore that their wages were taxable under FICA.

Petitioner Mayo Foundation for Medical Education and Research argued that this was an improper rule, and that medical residents should be treated as students under the plain language of the statute. In announcing the decision, the Court focused on the question of whether residents were “workers who study or students who work.”

The Court held that the Department’s regulation was a permissible interpretation of an ambiguous statute, and therefore that medical residents would be treated as employees for purposes of federal taxation and Social Security coverage under FICA. Chief Justice Roberts wrote, “The department certainly did not act irrationally in concluding that these doctors… are the kind of workers that Congress intended to both contribute to and benefit from the Social Security system.”

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Michigan Court of Appeals Rules State Law on Patient Privacy Trumps HIPAA In Certain Circumstances

HIPAA CompliantA new published health law opinion from the Michigan Court of Appeals could have some far reaching effects on HIPAA litigation.

In the case of Isidore Steiner, DPM, PC v Marc Bonanni, Dr. Bonanni was employed by Isadore Steiner, DPM, PC and his contract included a non-competition and non-solicitation provision. After Dr. Bonanni left his employment with them, Isidore Steiner, DPM, PC sued him for allegedly violating the non-solicitation provision of the contract and stealing their patients. In order to prove their allegations, Isidore Steiner, DPM, PC sought Dr. Bonanni’s patient list during the discovery portion of the case.

The Michigan Court of Appeals found that the patient list was not discoverable as it was privileged under Michigan law. The Michigan Court of Appeals held on April 7, 2011 that Michigan law protects the very fact of the physician-patient relationship from disclosure, absent patient consent; this means that the name, address, and contact information is protected from disclosure in litigation. The Court found that HIPAA (which would have allowed for disclosure) does not preempt state law on this matter because state law is more stringent.

Generally, HIPAA requires patient consent for the disclosure of protected health information, just as Michigan state law does. In litigation, however, HIPAA has special provisions that allow for the disclosure of protected health information in response to a subpoena or court order if the provider receives adequate assurances that notice was provided to the patient or that reasonable efforts were made to secure a QPO. However, Michigan law does not have such an exception and requires the patient’s consent to reveal private patient information. Thus, it would seem that non-solicitation provisions in employment contracts may potentially lose some of their weight unless a violation can be proven without reference to patient information. If an ex-employee violates this contractual provision, the employer does not have access to the ex-employee’s patient list to prove its allegations of violation of the employment contract under this latest Michigan Court of Appeals ruling.…

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HHS Publishes HITCH Breach Notification Interim Final Rule

HHSOn August 24th, 2009 we finally saw the publication of interim final regulations implementing the security breach notification provisions of the Health Information Technology for Economic and Clinical Health Act (“HITECH”).

While the regulations appear to parallel the statutory provisions of HITECH, the process covered entities must follow before notifying a patient of certain breaches of their protected health information (PHI) is not as strict as initially feared.

For instance, under the new regulations, covered entities will still engage in a very subjective and fact specific risk assessment before determining when to notify a patient of a breach. The regulations also provide guidance to covered entities and their business associates (BAs) relative to their mutual obligations under the new rules.

Summarized below are some key points and issues we perceive to be relevant to covered entities and business associates under the new regulations.

The Breach Rules Only Apply To “Unsecured” PHI.

Unsecured PHI is defined as PHI that has not been secured through the use of a technology or methodology specified by HHS. According to HHS guidance released in April 2009, encryption and destruction are the only two ways to secure PHI and avoid breach notification under the Act.

Click here for a link to HHS’ April 2009 “Guidance Specifying the Technologies and Methodologies That Render Protected Health Information Unusable, Unreadable, or Indecipherable to Unauthorized Individuals for Purposes of the Breach Notification Requirements”.

Fact Specific Risk Assessment.

The Regulations define a “breach” as the acquisition, access, use, or disclosure of PHI in a manner not permitted under the Privacy Rule that “compromises the security or privacy” of the PHI.” A use or disclosure compromises privacy or security only if it creates “a significant risk harm to the individual as a result of the impermissible use or disclosure.” The regulations identify a number of factors covered entities or business associates may consider during this assessment, including:

who impermissibly used or to whom the information was impermissibly disclosed;
steps taken to mitigate an impermissible use or disclosure (i.e. lost or stolen laptop is returned and forensic analysis reveals that its information was not opened, altered, transferred or otherwise compromised);
The Type And Amount Of PHI Involved.

In the event a notification is deemed necessary based on the facts all notification to individuals and HHS and must be given without “unreasonable delay,” but no later than 60 days after discovery.”

Exceptions to Breach Rule.

There are also key exceptions relative to the breach rule in situations where there is:

an unintentional acquisition, access or use of PHI;
inadvertent disclosure; or
disclosure of PHI to person not reasonably able to retain such information.

Business Associates.

Under the new regulations, BAs must comply with the privacy and security regulations, just like covered entities. BAs must have policies and procedures documenting compliance with the privacy rule’s use and disclosure provisions and the security rule’s administrative, physical and technical safeguards requirements.

An interesting issue is raised relative to when BAs acting as “agents” of a covered entity versus BAs acting as “independent contractors” and the breach notification time frames requirements under both scenarios. If a business associate is acting as an agent of a covered entity then the business associate’s discovery of the breach will be imputed to the covered entity. Accordingly, the covered entity will have to provide notifications to the patient and HHS based on the time the business associate discovers the breach, not from the time the business associate notifies the covered entity. Conversely, if the business associate is an independent contractor of the covered entity (i.e., not an agent), then the covered entity must provide notification based on the time the business associate notifies the covered entity of the breach.

Among Other Issues, BA Agreements May Need To Be Amended To:

clearly address the agent versus independent contractor status of the BA; and
the timing of BA notification to a covered entity following a breach.

Grace Period, Enforcement And Penalties.

Finally, the regulations account for a grace period allowance before HHS expects to begin enforcement. The regulations took effect on September 23, 2009, but HHS has delayed seeking sanctions until February 22, 2010.

The caveat to this allowance period, however, is that the regulations significantly broaden the enforcement and penalties associated with a violation. Under the new system, HHS will employ a tiered penalty system based on the mental state of the offender.

Additionally, HHS has also delegated some of the enforcement mechanisms to state Attorney General offices. Effective February 18, 2009, the Michigan Attorney General can bring actions under HIPAA independently of HHS. Finally, the regulations allow for penalties to be shared with those harmed by the disclosure (though, we have not seen regulations or guidance from HHS on the definition of the “harm” necessary to share in penalties).…

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Health Care Employers feel the Pain of H1N1 Vaccination Policies

H1N1 Vaccination PoliciesMany Hospitals and other employers in the health care industry are discussing the benefit of H1N1 vaccinations for their employees. Some are even considering mandating that employees receive the vaccination. After all, if your employees are “at will,” then you can impose new conditions of employment on them at any time.

On many levels, mandating the vaccine for health care workers makes sense. After all, OSHA mandates that employers provide their employees with a safe place to work. Doesn’t a mandatory vaccination ensure a safer place for employees to work? A healthy workforce also means less absenteeism. And, the idea of mandatory vaccinations isn’t totally foreign to health care: think TB vaccinations. I also compare a mandated vaccination to drug testing: somewhat invasive, but for the common good.

On the other hand, mandatory vaccinations raise many legal issues. For instance, if your workforce is unionized, then this would require negotiations with the union before implementation, as it affects the terms and conditions of employment. If you are non-unionized and have many employees opposed to the mandatory vaccination, a mandate may be what pushes employees to organize. Another consideration is that some have asserted that the vaccination is untested and potentially dangerous. If an employee is vaccinated over his/her objection, that may create liability for the employer if the employee experiences an injury or serious side effects from the vaccine.

While there are many good reasons to mandate the H1N1 vaccine, an employer who moves in this direction is definitely treading onto unsettled legal grounds.…

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OIG Work Plan – FY 2009

health care lawLast week, the Office of Inspector General (OIG) published its “Work Plan” for federal fiscal year 2009. Many health care providers use the annual OIG Work Plan as a road map to guide their annual compliance efforts and this has always been a strategy that I have supported.

Although I usually suggest that compliance officers and the health care providers they represent look not just at the current year’s Work Plan but the past two or three years Work Plans, collectively, I think it is very important for health care providers to be aware of what the OIG thinks it should pay attention to, in any particular year. Its also noteworthy to understand how the OIG’s focus changes from year to year and over time.

Of particular note in this year’s Work Plan is the continuation of some significant reviews and the initiation of others that are in areas where health care providers often struggle.

They include OIG’s review of:

Provider-Based Status for Inpatient and Outpatient Facilities
Hospital Owned Physician Practices Billed as Outpatient Services
Provider Bad Debt Allocations
Medicare Secondary Payer Compliance
Diagnostic X-rays Performed in Hospital Emergency Departments
EMTALA Compliance
Never Events
Physician Services Performed by Non-Physicians
Medicare Payments for Sleep Services
Services Performed by Clinical Social Workers
Outpatient Physical Therapy Provided by Independent Therapists
Payments for Colonoscopy Services

Given some of the questions that I have received from clients in the past six months, I see EMTALA Compliance and Medicare Payments for Sleep Studies as particularly interesting and suggestive of the fact that OIG and CMS think that providers are not doing things correctly in these areas.

Your compliance committee should take the time to review the new OIG Work Plan and modify its compliance focus accordingly.…

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