Levine R J, Guisto J A, Meislin H W, Spaite D W
Arizona Emergency Medicine Research Center, Health Services Research Program, Tucson, USA.
Ann Emerg Med. 1996 Jul;28(1):45-50. doi: 10.1016/s0196-0644(96)70138-5.
To identify the incidence of federally imposed penalties for violations of the Consolidated Omnibus Reconciliation Act (COBRA).
Under the Freedom of Information Act, we retrieved a copy of any document related to fines imposed on, settlements made by, or litigation against physicians or hospitals as a result of COBRA violations from the Office of the Inspector General. Under a separate inquiry, also under the Freedom of Information Act, we requested and received from the central office of the Health Care Financing Administration the National Composite Log showing the status of all complaint investigations pursuant to COBRA since the inception of the law.
One thousand seven hundred fifty-seven complaint investigations were authorized. Of the 1,729 investigations completed, 412 (24%) were found to be out of compliance with federal regulations. Of these, 27 cases resulted in fines imposed on hospitals. These fines ranged from $1,500 to $150,000 with a mean of $33,917, a median of $25,000, and standard deviation of $35,899. The six fines that were imposed against physicians ranged in value from $2,500 to $20,000 with a mean of $8,500, a median of $7,500, and an SD of $8,612. Seven hospitals but no physicians were terminated from the Medicare program for COBRA violations.
The incidence of federally imposed penalties for COBRA violations is low given the multitude of patient transfers that have occurred since the enactment of COBRA. The growing concern regarding this issue may be related to current litigation efforts to broaden the scope and applications of these laws.
确定因违反《综合预算协调法案》（COBRA）而受到联邦处罚的发生率。
根据《信息自由法》，我们从监察长办公室获取了与因违反COBRA而对医生或医院处以的罚款、达成的和解或提起的诉讼相关的任何文件副本。在另一项同样根据《信息自由法》进行的调查中，我们向医疗保健财务管理局中央办公室请求并收到了自该法律颁布以来所有依据COBRA进行的投诉调查状态的全国综合日志。
授权进行了1757项投诉调查。在完成的1729项调查中，有412项（24%）被认定不符合联邦法规。其中，27起案件导致医院被罚款。这些罚款金额从1500美元到15万美元不等，平均为33917美元，中位数为25000美元，标准差为35899美元。对医生处以的6笔罚款金额从2500美元到20000美元不等，平均为8500美元，中位数为7500美元，标准差为8612美元。有7家医院因违反COBRA被终止参与医疗保险计划，但没有医生受到此类处罚。
鉴于自COBRA颁布以来发生了大量患者转移情况，因违反COBRA而受到联邦处罚的发生率较低。对该问题日益增加的关注可能与当前旨在扩大这些法律范围和应用的诉讼努力有关。
