Methodological challenges to government sampling techniques in civil fraud and abuse cases.

This Article discusses the use of statistical sampling in Medicare and Medicaid fraud and abuse audits. The author reviews cases in which government sampling methodologies have been challenged. Finally, the author describes the various alternatives available for challenging the validity of the statistical sampling used by the government in its audits.

Actions for damages against medical examiners and the defense of sovereign immunity.

The doctrine of sovereign or official immunity has protected medical examiners in cases alleging negligent performance of the autopsy and in cases involving negligent harvesting of organs. It has not protected examiners in cases alleging performance of autopsy without authorization. The medical examiner, therefore, is well advised to determine whether there may be any objection by the next-of-kin to an autopsy and particularly any religious objection-and if there is such an objection, to proceed only after making contemporaneous and documented decision that there is a compelling need for the autopsy.

Legal considerations for periodontists in dealing with managed care organizations.

For well over a decade, increasing numbers of medical patients have transferred from traditional indemnity insurance to managed care organizations (MCOs). Increasingly, MCOs are enrolling dental patients as well. Consequently, it is important for periodontists to understand issues in negotiating with MCOs. This article attempts to advise periodontists regarding what they can and cannot do collectively about managed care and what considerations they should take into account in individually negotiating and dealing with managed care plans.

Legal issues for blood banks.

This article first examines the standard of care applied by courts in litigation brought against blood banks by persons who contracted the acquired immunodeficiency syndrome (AIDS) from a transfusion. It describes cases that have held as a matter of law that a blood bank was not negligent if it followed the screening procedures recommended by the government and the medical profession at the time of the transfusion. The article also sets forth cases that have allowed the issue of alleged negligence by the blood bank to be decided by a jury--even if the blood bank complied with governing regulatory and professional guidelines. It analyzes the reasoning applied in each line of cases. It then discusses judicial approaches to applications of the statute of limitations in transfusion-transmitted AIDS cases. The second part of the article addresses AIDS-related confidentiality issues for blood banks. Specifically, it examines (a) record-keeping procedures that blood banks should consider and (b) approaches to informing donors that their identities may not be kept confidential. It provides general guidelines for blood banks on how to minimize exposure to liability for breach of confidentiality.

The prognosis for the hospital-based pathologist--Part 2.

Last month the authors diagnosed the condition of the hospital-based pathologist and prescribed a large dose of competitive activities to improve security and financial well-being. In this concluding article the complications of this treatment are examined, highlighting the issues that pathologists must resolve as they venture forth into a new practice environment.

The prognosis for the hospital-based pathologist--Part 1.

Both the security and the financial well-being of the hospital-based pathologist have been shaken by ten major developments in the last five years. In this first installment of a two-part article, the authors review these events and the symptoms they have produced. Following their diagnosis, they present a comprehensive plan of treatment.

CAP v. Heckler and HCFA's modification of TEFRA regulations.

Although the Court of Appeals did not invalidate the Health Care Financing Administration's TEFRA regulations, HCFA did make favorable changes in the regulations in response to the College's lawsuit. Here, the authors detail the important areas in which HCFA reversed its position during the course of the litigation, and describe other aspects of the suit.

What the regulatory developments mean for pathologist-hospital contracts.

Flexibility is a key concern today for pathologists negotiating contracts with hospitals. Here, the authors explain why it is important, and they pinpoint specific contractual provisions that provide this flexibility.