Beth Worthy
11/21/2014
The medical transcription industry at one time was heavily criticized for unethical business practices. A big reason the industry fell under a dark cloud in the past was that it was unregulated as transcription companies raked in cash from false data. Today after a decade of reform and mergers, it's a $12 billion industry that handles almost 60 percent of all clinical documents in the United States. The following information examines how the transcription business has cleaned up fraudulent practices.
One of the growing problems in the healthcare industry in the new century has been Medicare fraud. Inflated billing has cost the federal government billions of dollars. Submitting fraudulent bills to the government is a violation of the False Claims Act. Part of this problem was due to unethical practices among small companies in the transcription industry. But the government has stepped up its surveillance of Medicare fraud and has been issuing heavy fines in recent years, giving companies big and small less desire to commit fraud. Small companies in particular cannot afford massive fines. Many small companies have since dropped off the radar as the transcription industry quickly has been taken over by large companies that make accountability a priority.
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Offshoring became a growing concern in the mid 2000s, as many companies began to take advantage of lower labor costs in other countries. It opened the door for low paid outsourced workers to lower the quality of data collection. The transcription industry faced a shortage of workers as well as pressures for increased turnaround times as quality control became a lower priority. Consequently, the integrity of protected health information (PHI) was breached by overseas workers who had little incentives to show company loyalty. In 2003, for example, a transcriptionist in Pakistan was upset about not receiving compensation so she threatened to publicly expose patient records from the University of California, San Francisco Medical Center.
The foreign outsourcing problem caused the American Health Information Management Association (AHIMA), a sister organization to the Association for Healthcare Documentation Integrity (AHDI), to analyze the transcription industry more closely. The result was AHIMA published a list of questions for health care professionals to ask transcription organizations in order to make sure that data was more secure even when transcription work was outsourced overseas. Another development was the rapid adoption of technology platforms that eliminated the need for home-based offshore transcriptionists to download sensitive data.
After receiving over $1 million in a class action settlement against MedQuist for helping to unethically fund transcription businesses, the AHDI began work on its Manual of Ethical Best Practice for healthcare documentation organizations. The manual was released in 2010, guiding transcription businesses on new policies regarding privacy, security, billing, compensation, outsourcing, marketing, time/date stamping and ethical practices. The manual includes guidance on how transcriptionists are to deal with unethical requests that violate policies or compliance.
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Two key turning points that led to tighter regulations of the transcription industry in 2009 were the strengthening of the Health Insurance Portability and Accountability Act (HIPAA) 2009 and the passage of the American Recovery and Reinvestment Act (ARRA). Title II of HIPPA called for setting national standards for electronic healthcare transactions. ARRA established the national adoption of clinical information systems such as electronic health records (EHRs). These new laws helped spawn ethical guidelines for the transcription industry that introduced audit control and user identification safeguards when business associates accessed electronic records, which were required to be stored in secure data centers. These ramped-up securities provided more control over how home transcriptionists could access PHI.
PHI has helped straighten out the transcription industry, making it more difficult for fraud. Standards have been established as medical transcription service organizations (MTSOs) now put a heavy focus on accurate patient care documentation. The AHDI, which was founded in 1978, now acts as a disciplinary organization overseeing healthcare documentation. The organization establishes industry requirements and works through legislation to improve the protection of patient healthcare records. Although fraud may still exist among certain sectors of health care, the transcription services industry now appears to be in full compliance.
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