Deficit Reduction Act , False Claims Act and Employee Protection

The Deficit Reduction Act and the False Claims Act combine to offer employee protection against fraud and waste and whistle blower protection, too. Compliance with these acts is key to health care program funding and keeping medical care and medical care givers both safe and sound.


First, an overview: the 2005 Deficit Reduction Act set up a new Medicaid Integrity Program quite similar to the Medicare Integrity Program. Vastly increased funding means vastly increased scrutiny of Medicare and Medicaid. This has become an increasingly vivid hot spot for government regulation, and is exactly what the False Claims Act is intended for.

When an organization is on the radar of the Medicaid Integrity Program, one area in particular that will be studied is whether the organization properly and adequately communicated all the information about the False Claims Act, and about the whistle blower protections communicating the details of the False Claims Act (FCA) and the whistle blower protections.



Concerned as to whether or not you’ve handled these details, assessed and addressed them? MedTrainer can help. Our training program is designed to ensure compliance in a wide spectrum of areas for medical, dental, and veterinary care givers. Unsure or overwhelmed about all the detailed information to be imparted? We can offer the comprehensive information coverage you need to keep your staff focused and knowledgeable - without the hassle.

After all, the False Claims Act requires knowledge to successfully implement. As a recipient of federal health care program funds, such as Medicare and Medicaid, you’re legally required to include all of its policies and provide thorough information about the federal False Claims Act to all employees and contractors. You also need to provide information about all state civil and criminal laws dedicated to the prevention and detection of fraud and waste in health care programs.

A federal law that makes it a crime for any one to make a false record or file a false claim knowingly to a federal health care program, The False Claims Act includes any plan that provides health benefits funded directly by the federal government or a state health care plan.


In short, knowing that a claim is false, or disregarding evidence that a claim may be false, is illegal: whether that false claim involves over billing Medicare for services, submitting inaccurate claims for provided services, or billing for services that were not provided. The False Claim Act deals with both patient fraud and care giver fraud and waste. Other examples include billing twice for the same service; billing for medically unnecessary services or creating false certificates indicating  medical necessity; billing for services separately that could be billed as one; creating false medical records or treatment plans designed to increase payments; failing to report and refund over payments. Other situations could include a physician billing for services rendered by medical students, interns, residents or fellows in teaching hospitals; and giving or receiving unlawful inducements for referrals for services from other health care providers.


The False Claims Act has provisions built in so that individuals with information about fraud in government health care programs can file a lawsuit on behalf of the government. These individuals can, should the lawsuit succeed, receive a portion of the recovered amount received by the government.

In most states, it is a crime to obtain a Medicaid payment or benefit by providing false information. Like the federal government, most states have laws on the books that allow individuals to file a lawsuit for false claims filed for payment.

Penalties for violating the False Claims Act are steep indeed. Financial costs can add up to as much as three times the cost of the claim made plus fines of between $5500 and $11,000 per claim. And fines and penalties aren’t the only substantial downside. Courts can impose criminal penalties too - against individuals who violated the act and against organizations who perpetrated willful or reckless violations.


Making sure your staff knows the tremendous implications of ignoring fraud or pleading ignorance to fraud and abuse is vitally important.

Along with the penalties and enforcement, the False Claim Act also offers protection - for anyone who files a lawsuit under the act. This protection serves to prevent an employee from firing, demotion, threats, and harassment incurred if the employee files a False Claims Act lawsuit.



Being fully committed to complying with health care organization laws and regulations means establishing a compliance program that clearly states your cooperation with and commitment to the legal program.

Such a compliance program includes a statement that outlines the conduct standards expected within your organization, including appropriate policies and procedures. In includes training and educating all staff members, setting up systems for auditing and monitoring, and having in place the proper channels for individuals to present any issues or concerns - without retaliation. All of these compliance materials should be easily accessible online, in employee handbooks, and handouts, and as a company policy to work with honesty and integrity.



Providing employees with information is a requirement of the Deficit Reduction Act. Signed into law in 2006 by then President Bush, the law requires states who participate in Medicaid to demand that providers who receive or make a minimum of $5 million under that state’s Medicaid program, will set up written policies for employees, contractors, and any agents to review. These written policies must give detailed information the False Claims Act, the federal Program Fraud Civil Remedies Act, whistle blower protections, and any additional or supplemental federal and state laws regarding both criminal and civil penalties for false claims and statements. Information must also be provided about the way these laws prevent and can detect waste, fraud, and abuse. And, procedures and policies must be established by the provider to prevent and detect waste, fraud, and abuse. Finally, to be in compliance with the DRA, any employee handbook
of a covered entity must include both a discussion of these laws and the rights of employees protected as whistle blowers.



Yes, there’s that word again, compliance. It is as much a part of health care and the medical profession today as the treatment of patients. Failure to comply with education requirements may cause ineligibility to receive Medicaid payments. A knowing violation of the education requirements can also result in strong penalties for submitting false claims under the False Claims Act for non-compliance.



Along with the Deficit Reduction Act, False Claims Act, medical practices of all kinds need to adhere to OSHA standards, developed to reduce hazards in the work place and successfully implement both safety and health programs. The OSHA act of 1970, like the DRA and the False Claims Act, stop an employer from discrimination against or discharging of an employee who has made a complaint, exercised a right, or participated in an investigation. HIPAA, the Health Insurance Portability and Accountability Act which  serves to establish standards of security and privacy, must also be adhered to, as does the Patient Safety and Quality Improvement act of 2005, which ensures a confidential reporting system for health care professionals to report errors and safety compromises.

In summary, from the DRA and False Claims Act to HIPAA, new laws, rules, and regulations have been established by the federal government and by state governments, to protect patients, and to prevent waste and fraud. Being in compliance with these rules and regulations, adhering to these federal laws, means educating all medical staff, and implementing written guidelines, training, and education programs. This is a lot to have on any care givers plate. MedTrainer can help you with training and education, achieve compliance, improve your efficiency, and help you to prevent the very things these laws were designed to prevent: waste, fraud, and abuse.

Waste Classifications, Regulations – Disposal and Recycling Techniques

Waste not, want not. You remember that old saying. Well, in the case of medical waste, the saying mutates to waste not poorly, if you want not to have issues in terms of waste disposal compliance.

Disposing of medical waste is a challenge for any medical, dental, or veterinary practice or hospital. If you need help in regard to understanding waste classifications and regulations, and utilizing disposal and recycling techniques adequately, MedTrainer can help. Our compliance training programs are designed to cover all aspects of medical compliance including waste handling.

Health care facilities produce a variety of waste. Many are regulated at the state and local level, others at the federal. Regulated medical waste for infectious materials are usually governed by state regulations, while the hazardous waste materials are regulated by the federal government. Just knowing the regulations and being able to respond to them successfully is difficult; finding the best ways to comply can be a “waste” of precious manpower. Knowing the regulations you must adhere to, and finding compliant disposal techniques are vitally important to the over all health of your practice as well as your staff and community.

So what about handling practices? First of all, infection risk is a major issue. Pathological waste, lab cultures, sharps - all quite dangerous in terms of the possibility of contracting an infection, and careful handling of disposal is key to prevent that possibility.

Second, there is the classification of hazardous waste disposal. Toxic materials such as chemotherapy compounds much follow additional rules based on special regulation under the Resource Conservation and Recovery Act established by the Federal government, as well as following additional state rules in many locations. In short, wastes that are regulated as both medical and hazardous can be a true challenge, as many disposal service providers who handle medical waste cannot accept hazardous items - it can be difficult to find disposal that takes both types of waste.

Most states require that all medical waste is treated before being disposed of in order to reduce risk to acceptable levels. States often have different requirements for waste types and disposal.



The main goal of any waste treatment and disposal system is to make waste noninfectious. Incineration was the first technique used to accomplish this, and while the public was kept safe from infection, generators released toxic substances into the atmosphere. EPA emission standards changed, and so did the necessity for closure of manyon-site medical waste incinerators at medical facilities. Few still operate. Now, many facilities ship waste to a centralized, monitored incineration location or use other options.
Additional waste treatment options include the use of excessive heat or contact with chemical materials designed to render them sterilized. Techniques include the use of microwaves systems, steam autoclaves, or dry heat/hot air for heat treatment. For chemical agents, the usual methods are chlorine, ozone, alkali or a combination of these treatments.


When infections materials are involved, the waste treatment must be sufficiently strong to penetrate every section of the waste. Sometimes the best way to do this, particularly when dealing with anatomical waste, is to shred or grind the materials to bring the interior to the surface. Of course there is additional cost and maintenance involved in this process, and the riks of releasing pathogens through grinding or shredding must be taken into account with careful handling on equipment which has been specially designed for the processing of medical waste.

The biggest down side to incineration is air quality issues and efficient energy usage. Many large amounts of fuel must be utilized to destroy waste, much of it used to boil water from the waste so that the organic materials will burn. This generates greenhouse gas, and is also quite costly.



Thermal treatment on the other hand utilizes high water content to advantage. Water helps to transfer and distribute heat throughout the mass of waste. Performing this treatment in a pressure chamber raises the boiling point of water sufficiently to kill most organisms. Autoclaves are particularly effective at this. In a microwave system, this type of thermal treatment subjects the waste to high intensity radio waves, efficiently delivering energy where it’s needed to sterilize. However microwave processing can be less efficient if waste is too dry.

With either autoclaves or microwaves there is no emission from disposal. On the downside, these systems are expensive. Dry heat systems are less costly, but do necessitate the use of higher temperatures and longer waste exposure time periods. As dry heat systems don’t involve combustion, unwanted reactions aren’t an issue. Air moving through the system however can carry pathogens, creating the potential for release of them.



Each of these systems require a minimum time of contact to fully destroy pathogens and process waste in a shorter time period. One method that produces the temperature desired is a plasma arc, a technique of electric discharge that creates an intense heat without combustion.

Chemical treatment is another form of waste treatment. Convenient and cost effective, they do however consume chemicals and create chemical based reactions present in the waste that can cause its own set of problems. Chlorine is a common option, working by stripping electrons out of organic compounds and oxidizing them.  Ozone and Alkaline agents are also used, and it is important to avoid exposure to ozone due to the possibility of lung damage, and to alkaline agents which can damage both skin and lungs. Risks must always be carefully weighed.

 So, once waste has been rendered safely noninfectious, it still must be disposed of. Most categories of waste can then be handled like any other solid waste. But hazardous waste cannot be - it must be disposed of in compliance with regulations.



There are also several types of regulated medical waste that require specific treatments, for those
associated with infection spread, such as pathological waste, lab cultures and sharps - such as needles and scalpel blades.

In the latter case, sharps must be disposed of in special containers and processed or encapsulated. Individual states have detailed regulatory rules. Sharps have more regulatory rules than other medical waste categories.

And what about hazardous waste materials? Many provisions and regulations apply here too, particularly in regard to the mixes of hazardous wastes, indicating that otherwise non-hazardous waste, if mixed with even a minute amount of hazardous waste, falls under restrictions applying to hazardous wastes.



These mixed wastes offer many challenges all their own, as most hazardous waste haulers cannot handle medical wastes, and is the rare medical waste disposal facility permitted to accept hazardous items.



What’s a health care practice to do? Minimizing the amount of this type of waste whenever possible is a good start, using special containers to hold the waste, and adhering to both state and federal regulations regarding containment.

Disposal and recycling techniques for medical waste depends upon type of waste, such as hazardous, or anatomical, state and federal rules and regulations, and the types of disposal techniques available to you.

The place to start is with knowledge of classifications and regulations, followed by assessing the best disposal techniques in terms of safety, efficiency, and cost.

Health comes first, and regulations focus on that, but there are intricate details of rules that may make compliance more difficult than it should be if staff is not adequately trained to recognize them. Train for health and compliance, for safety and security. That’s the bottom line regarding waste disposal and classification knowledge.

Radiation Orientation and Safe Work Practices

Safe work practices regarding radiation require considerable training. Before a health care worker begins to use radioactive material or a machine that produces radiation for patient care, proper supervision must be taken.



The must here refers to the health of both the worker and the patient being treated - and to OSHA compliance. If your health care practice - whether dentistry, veterinary, or medical - deals in radiation treatments of any kind, OSHA rules are strict. They’re strict for a reason: radiation exposure can be very damaging. As such, fines for non-compliance are strict, too.

Training is, in short, vital - and if your practice needs support, MedTrainer is here to help with online programs designed to specifically address safe work practices involving radiation.

So, first of all, what rules affect what workers, and what safety standards should be in place? Unless you’re Spiderman, getting a dose of radiation of any kind doesn’t result in super powers - it is a serious matter, and one that should be handled judiciously.


All staff, who in the course of a year’s employment, are likely to receive an occupational dose of radiation in excess of 100 mrem are considered radiation workers. Anyone who handles radioactive materials in the course of work must be trained in radiation safety, and carefully supervised while performing such work until their training has been completed. Yes, there’s a grey area as to whether or not all staff using radiation-producing machines are radiation workers, but it is always best to err on the side of caution when working with radioactive material or a radiation producing machine.

The bottom line: protection. Radiation protection consists of a variety of controls, including:

• Machine design and construction
• Administrative policy/procedures
• Personal protective equipment

Personal protective equipment must take into consideration time of exposure, distance from exposure, and shielding methods. It is considered the last form of defense in regard to reducing radiation exposure. Prior to this defense of course is the optimization of other controls in regard to the machines producing the radiation, and the time limits set in regard to exposure.

An employer, a supervisor, and the staff member handling the radiation all have certain areas to consider in regard to protective devices.



As an employer, a medical, dental, or veterinary practice must be all means ensure devices are in good shape, adequately provided, and used in the way they should be used. All of these areas lead back to the absolute necessity of training in order to be in OSHA compliance.

At the work place, the supervisor must make certain that the staff member subject to radiation exposure uses the protective garments or devices, handles materials safely, and follows safety measures.

And the staff member him or herself? He or she must use or wear protective devices, report defects, and understand the importance of protection through completion of OSHA required training.

The goal? To  ensure radiation doses received by workers are as low as possible and meet limits in regard to safety.




OSHA requirements vary in regard to the particular position being regulated. For example, in regard to those staff members using X-ray equipment, the X-ray Safety requirement is for protective aprons and gloves that provide a shield of at least 0.5 mm of lead.

All workplaces must develop and use written measures and procedures about safe work practices in regard to radiation exposure.  The use, maintenance, and care taken with radiation producing equipment, the care and wearing of protective garments, and criteria for staying up to date in regard to radiation safety and orientation are all key elements of proper OSHA compliance. Protective garments must be hung, not folded or wrinkled. This can damage them.



And here is another key element: employers are required to develop, and provide training and educational programs on the measures and procedures involved in radiation safety. So the health care employer’s responsibility for personal safety is not limited to providing the proper attire or equipment - it also must encompass the instruction and training of workers.

A staff member who must wear or use protective clothing, equipment, or devices must receive instruction on that protective gear’s wear and use before utilizing it.

OHSA also requires that risk assessment and control be set into place to assess staff members needs for protection and training. The selection of personal protective equipment, the roles and responsibilities of staff members in regard to obtaining this equipment and using it, and the establishment of control measures to minimize exposure to radiation must all be acted upon.

Care must also be taken, both that the personal protective equipment meets lead shielding requirements and is labeled to show that it does. There are specific areas that the PPE must accomplish: that it covers the parts of the body it is intended to protect in every posture your staff member may assume during a procedure, and that it allows full mobility. As well, it must fit properly, and be stored correctly by hanging or draping, and be regularly inspected and maintained to be sure no wear and tear has occurred, check for defects, and be properly cleaned.



Staff should also be appropriately trained regarding the selection of the PPE, its limitations, and proper storage, maintenance, and inspection. After all, the effectiveness of personal protective gear is completely reliant on the gear’s construction, fit, and how well they are used. If they are poorly made, fitted, or used, they cannot help in reducing exposure to leakage or scatter radiation.
And that’s not a scenario you want to have in place.

That’s a lot of information for staff members to take in. And of course it’s vitally important that PPE shielding is as great as a 0.5 mm thickness necessary for a particular radiation application.

Is your staff adequately trained to recognize the appropriate construction and fit of lead aprons, thyroid collars, leaded glasses, and gloves?

For example, wrap-around aprons should cover the entire front of the body to the posterior midline. A thyroid collar and apron should fit together with no gaps. Open backed aprons cannot be used in intensive radiation dose procedures such as angiography. Additional consideration should be made as to the ergonomics of the personal protective gear, too.

Remember ergonomics? We discussed the importance of proper ergonomics in the workplace in our last blog. But it comes into play with personal protective equipment and safe work practices too. After all, protective equipment can weight quite heavily on the body.



Lumbar support? Yes, weight belts and padded shoulders can improve comfort, and reduce the back strain and injury. Redistribution of weight can be helpful to avoid putting too much weight on parts of the body, specifically joins. Using separate skirts and tops can help.

Knowing the necessary use of leaded glasses and gloves, and labeling as to their effectiveness and thickness is also important.  There is no point in providing gear if it is not effective!

Which leads to the next point regarding safe work practices and OSHA compliance: quality assurance testing. Every six months the PPE should be examine both visually and by touch for signs of tearing, separation from stitching, distortion, or puncture. And, at least annually, a fluoroscopic exam should be conducted. If the equipment shows any signs of visual defects, or through touch or x-ray exam, it must be replaced or repaired.

In summary, hospitals, veterinary clinics, radiology clinics, and dental clinics offering X-rays must be effectively monitored for compliance to protect the health of medical staff. Exposure to radiation can cause cancer, tissue or genetic damage, and defects in unborn children. Eye injuries can result from lasers and ultraviolet radiation.



Being proactive for the safety of your staff and to prevent non-compliance means monitoring of X-ray exposures, magnetic resonance imaging or MRI exposure, and laser sources, and inspection of personal protective equipment. A proactive approach to radiation orientation and safe work practices also means training in the safe use of lab materials and equipment, the safe use and storage of protective clothing, and protocols for operating radiation producing equipment. Safe handling, storage, and disposal of radioactive materials, producing and maintaining records, and establishing solid emergency procedures are all a necessary part of planning for staff health and safety - and OSHA compliance.

If you need assistance with developing proactive methods for radiation orientation and safe work situations, and training your staff for safety and compliance,  MedTrainer is here to help.

Ergonomics and Injury Prevention

Ergonomics. The word reminds you of something involving oddly shaped chairs or soft keyboards. Or perhaps it sounds like something nice to have but maybe not that not necessary. But nothing could be further from the truth. Employing ergonomics is essential to prevent injuries and keep your staff working at peak performance, as well as following OSHA guidelines.



What is ergonomics and just how does it prevent injury? Let’s start with a look at ergonomics itself and take a body-improving look from there.

Ergonomics means planning, designing and evaluating equipment and environment to maximize productivity and reduce discomfort and weariness. Healthy design means healthy bodies, in other words.

From the standpoint of OSHA requirements and workplace compliance, there are no specific regulations. But intent exists - the intent that an employer has an obligation to keep a workplace free from hazards. Those hazards, as defined under the General Duty Clause, include ergonomic ones.

In short, although no specific regulations exist, OSHA can and will cite for ergonomic hazards. The idea being that employers should find and use equipment and procedures that will eliminate or at least reduce ergonomic hazards. That’s perhaps a little vague, and from the compliance standpoint, your practice may need a little help with defining compliance in this regard. If so, MedTrainer is here to help, with a full understanding of just what OSHA is looking for, ergonomically speaking, that is.

So what are those ergonomic hazards, exactly? We’re looking at what the Center for Disease Control notes as the potential for musculoskeletal disorders - back, wrist, elbow, shoulder injuries caused by workplace functions such as exertion, repetition, or awkward postures. Carefully designed work space, work space furnishings, and work breaks can eliminate or reduce many of these.



In the health care arena, ergonomics basically covers work situations that can cause operator injuries through fatigue or discomfort. Common injuries include those to hands, wrist, arms, and legs. After all, many health care industry jobs necessitate being on your feet for long periods of time, lifting patients or assisting them, lifting heavy objects, or data entry work that strains wrists and hands with repeated typing functions.

Ergonomics is an important tool to employ to prevent injuries and create a more positive workspace - as well as to adhere to OSHA regulations. Keeping your staff healthy also benefits you in terms of a more productive work place, less downtime, and less medical care costs.

Let’s look at what happens if successful ergonomics are not employed. If a person is working in a way that isn’t ergonomically friendly, it can create stress throughout the body. In turn, that stress, whether created through awkward positions, lifting strain, working in extreme temperatures of hot or cold, or utilized repetitive movements as with data entry, the stress can cause initial problems that lead to more permanent issues. In other words, discomfort, strain, fatigue, or pain in the short term can cause musculoskeletal disorders. The goal of ergonomics is to prevent these problems in a several common ways.



In regard to office work, surface heights can be adjusted to prevent or lessen bending. Phone handsets can be replaced with headsets to reduce neck strain. Readjusting a computer work station can reduce uncomfortable positions that create bent wrists when using keyboard or mouse.

The purpose of office ergonomics is to set up office space so that it fits the employee and the job her or she is doing. With a correctly set work station, employees will be less likely to experience neck or back pain, headaches, eye strain, tendonitis or bursitis. These can all be caused by a work space where repetitive functions are performed and ergonomic thought is lacking. Poor ergonomics can lead to injury and illness that cost time and money - for staff and employers, as well as affecting job performance.

Office ergonomics often help staff work more comfortably, which not only reduces injury from awkward positions and repeated tasks, but helps them lower stress, too. Look at the position of the workstation, the type of movements made repeatedly, temperature, light, and noise in the work area.

The idea of successful ergonomics is to make the work place both more safe and more efficient. The end result is improved employee health, reduced chance of OSHA fines, and company
success due to less turn over and more comfortable employees.

Nursing assistants who must lift heavy patients or stand for long periods of time without a break have different ergonomic challenges to overcome. Back aches and tired feet can lead to long term injuries to the back. Practicing proper lifting techniques, and reporting discomfort before it turns into an injury are key techniques to alleviate long term issues. Because this work can be mentally stressful as well as physically strenuous, it’s also important to allow break time and rest periods - it will help prevent injuries and make staff more relaxed, and more capable with patient handling.




A rested staff mentally and emotionally creates a sounder staff physically. Risky situations can be avoided and fatigue related injuries diffused before they occur.

Regardless of the type of ergonomics program required to improve work conditions, a commitment to discussion with staff is important to resolve issues and prevent them collaboratively.

So how do you become ergonomic? Many solutions are relatively simple, and all are designed to reduce bodily strain and fatigue, whether it’s caused by lifting, body position, or uncomfortable temperature or vibrations.

With medical assistants of all kinds, medical staff, and nurses and nursing assistants at the top of OSHA’s list for ergonomic hazards, it’s vitally important for medical practices of all kinds, whether hospitals, medical or dental offices, or pharmaceutical work situations, to address issues before they become serious problems.

Not only does this benefit employees and employee health, but it will help staff to be both more efficient and more productive, and will prevent mistakes on the job. With less fatigue and discomfort, focus and successful outcomes rise. Also, fewer injuries means less sick days, or employees who can not fully complete tasks at their standard level. Health insurance use and workers comp claims will also drop.

And your practice will be happier, too. Healthy, pain free staff members equals better morale and productivity, increased staff retention, and reduced turn over. All of these are the natural result of
healthier, safe, and pain free employees.



Of course OSHA plays into this dynamic too. OSHA citations can arise if you are not correctly utilizing ergonomics in your practice. Ergonomics, as previously noted, are referred to in OSHA’s General Duty Clause. And it is through this clause that large fine can be levied, pertaining to musculoskeletal disorders. When these disorders occurred bacuse companies failed to reduce risk of injury for their workers, fines are steep indeed.

Improving workplace ergonomics continues to be an on going concern, that when properly addressed as a priority reduces injuries and benefits both staff and the workplace.

The bottom line: ergonomics in the workplace should be dealt with proactively, analyzing
issues, responding quickly to employee complaints or concerts, and using quantitative tools to focus on job conditions before injuries happen.

Companies with effective ergonomics in place look at it as a process, one that collaboratively engages staff and management alike across an organization, providing a logical way to determine issues and get improvement, quickly and efficiently.

While ergonomics programs once depended on site "experts," making each employee and supervisor accountable is a critical element of successfully addressing ergonomics as a process.
New processes and equipment are integrated into the environment organically, to eliminate risk factors as much as possible, whether it is through adjustable work stations and chairs, staff training, self-assessments, or built in work breaks.

Regardless of the tools you utilize, working with ergonomics is an essential way to provide a safe and healthy environment, and help your practice to thrive.



If you’re not sure how to proceed with ergonomic appraisal and utilization, or what OSHA requires in specific situation, MedTrainer’s team of experts can help you find out.