Giving information to patients about schedule 2 drug stocks at a retail pharmacy in Florida (US) Context: There is currently a nationwide shortage of Adderall, a schedule 2 drug. One of the pieces of advice for patients is to see about getting the drug in a different formulation, as not all versions of Adderall are equally out of stock (Size of pill, extended release vs immediate release, etc.). Not knowing how quick or diligent my medial provider would be, I attempted to do my due diligence in finding out what would be in stock before contacting the prescriber, thus reducing the size of the task I was asking for. I was told by the pharmacy staff that since this was a schedule II drug, they could not share that information of what they had on stock with a patient. The only way to get that information would be for the provider to either send in an Rx for something that might not be on hand or for the provider to call the pharmacy and talk to them directly. I've been trying to determine if this is actually a law or just a store policy. I read http://www.leg.state.fl.us/statutes/index.cfm?App_mode=Display_Statute&amp;URL=0800-0899/0893/Sections/0893.04.html in detail, the Florida statute governing pharmacy behavior on controlled substances and could not find anything there. I then skimmed the rest of chapter 893 and did not see anything there. I then did my best to skim the US code 21 USC 13 but could not find anything there either. This pretty much exhausted my &quot;not a lawyer's&quot; ability to research this topic. So...is there something in either state or federal law preventing this communication, or just store policy? The main reason I want to know is if it is the former, I'd like to put forth a proposal to the appropriate agency that during a declared nationwide shortage of a drug (Which the FDA has done), these communication rules be lowered or waived as not all patients have on the ball providers...and keeping people in frustrating, difficult, out of control places with regards to their psychiatric medication does not seem to be a great idea!
I don't know of any law, state or federal, that would prohibit the disclosure of these facts. Such a law would almost certainly be unconstitutional under Va. Pharmacy Bd. v. Va. Consumer Council, 425 U.S. 748, (1976). In that case, consumer groups sued to invalidate a Virginia law prohibiting pharmacists from disclosing the prices of their products to the general public. The state argued that &quot;purely commercial&quot; speech did not enjoy First Amendment protection, but the Supreme Court disagreed, holding that unless it is deceptive or misleading, commercial speech enjoys normal First Amendment protections: Virginia is free to require whatever professional standards it wishes of its pharmacists; it may subsidize them or protect them from competition in other ways. ... But it may not do so by keeping the public in ignorance of the entirely lawful terms that competing pharmacists are offering. In this sense, the justifications Virginia has offered for suppressing the flow of prescription drug price information, far from persuading us that the flow is not protected by the First Amendment, have reinforced our view that it is. Va. Pharmacy Bd. v. Va. Consumer Council, 425 U.S. 748, 770 (1976). I'd therefore assume this is just a matter of store policy. From the pharmacy's perspective, advertising its inventory of controlled substances probably makes as much sense as putting up a sign advertising how much money is currently in the cash registers.
It is capitalized because the word NEXIUM has a conspicuous definition. In other words, they're using it in the specific way they have defined it to mean. This is to differentiate it from any other meaning it may have in some other context. Obviously with NEXIUM, it's a word they just made up and it's very unlikely that it could ever be confused with anything other than their particular drug. But what if the drug were called PRAXIA? The word praxia might be confused with the medical term. It's also the name of a city in Romania (I just learned that while looking that word up). But PRAXIA in all caps refers specifically to their drug, and there can be no ambiguity between that and other uses of the term. This is especially important for drugs, since they are legally required to disclose the side effects in their advertising, and you wouldn't want someone potentially confusing the name of the drug with the condition it treats. You see this in contracts as well. When a contract provision is written in ALL CAPS, it is done to conspicuously call attention to the text, either because it is redefining an established legal term or is modifying rights you may have under the law (e.g. LIMITED WARRANTY, SEVERABILITY, BINDING ARBITRATION, etc.) There is no established rule for this, by the way. It's mostly a matter of style. Some laws require conspicuous disclosure of certain provisions in contracts, so ALL CAPS has traditionally been used to meet that requirement. NOTE: The term "Nexium" (not in caps) is simply the registered trademark for the drug. It simply protects their intellectual property (i.e. the name), and isn't intended to describe or define anything in a legal way. Fun fact: Subway got sued for making "Footlong" sandwiches that were not actually 12 inches in length. They tried to argue that "Footlong" was a trademark and not intended to convey the length of their sandwiches. They settled the lawsuit, because really, that's a jackass move right there. I wonder, though... If they'd called it a FOOTLONG, would that have made a difference? ;-)
As it turns out, Talgov has a convoluted way it bills taxes which it doesn't explain on its bills or website. Its website claims to bill electricity at a rate of $7.59/month + $0.10522/kWh but, with taxes, it actually comes to $8.5631 plus $0.11598/kWh. On top of the advertised rate, it bills a gross receipts tax of 2.56406%. It also bills a public service tax of 10% on the monthly charge + $.07792/kWh + the gross receipts tax. That gets you the higher effective billing rate I mentioned above. The $.07792/kWh is reached by replacing the ECRC rate from the website with $.0077/kWh--I don't know why and I can't find an official document saying this--but that's what is happening apparently. So, Talgov doesn't bill sales tax after all and private residences are not exempt from the taxes it bills. Thus, it has not overcharged me a tax I should be exempt from and Talgov is allowed to do what it is doing, but it would be better if they represented their billing rate more honestly on their website. I'm also still not sure how they reach their 2.56406% gross receipt tax rate. The Florida statute that addresses gross receipt tax seems to specify either 2.5% or 2.6% (I can't figure out which should apply), but not something in between: (b) 1. The rate applied to utility services shall be 2.5 percent. 2. The rate applied to communications services shall be 2.37 percent. 3. An additional rate of 0.15 percent shall be applied to communication services subject to the tax levied pursuant to s. 202.12(1)(a), (c), and (d). The exemption provided in s. 202.125(1) applies to the tax levied pursuant to this subparagraph. 4. The rate applied to electrical power or energy taxed under subparagraph (a)3. shall be 2.6 percent. I found the information about the Talgov tax rates in a document from a Jacksonville utility company that compares utility rates for various utility companies, including many in Florida. Some Florida companies use a 2.5% gross receipt tax and some use a rate between 2.5% and 2.6%. This is also strange because that Florida statute seems to suggest the rate should be uniform statewide. TL;DR: Talgov is not charging sales tax, but rather some other taxes that I am not exempt from. I was able to figure out what rates they were charging for those taxes, but not why.
It is conceivable that A's employer would claim that the intellectual property was actually created by A in the course of their employment rather than B. That would be a question of fact for the lawsuit to determine. Realistically, assuming A and B both testify that B created the intellectual property with no input from A and A's employer had only the IP address as evidence, it is pretty unlikely that the fact finder would find that A created the intellectual property. A's employer would almost certainly need to provide some additional evidence that would show that the balance of probabilities favored the employer's position (i.e. A works at FedEx writing software for package logistics, B is a 12 year old kid with no formal computer science training, and the intellectual property in question involves the implementation of sophisticated graph traversal algorithms that would be common in package logistics applications).
The relevant legal requirement to have accurate records is 45 CFR 156.526, where An individual has the right to have a covered entity amend protected health information or a record about the individual in a designated record set for as long as the protected health information is maintained in the designated record set. The request can be denied if the record is accurate and complete. A simple and pointed solution is to print that page and circle the section, in a letter requesting an amendment. A somewhat more costly and much more effective solution would be to get a lawyer to write a letter in legalese. It is hard to imagine that the provider would not comply. You will notice that they have 60 days to comply (+30 days extension if requested). If for some reason they insist on leaving the record as is, you have the right to insert rebuttal statements into the record (basically, prove that the record is false). There is no realistic hope of compensation for annoyance, but you can hope for a correction.
The health insurance contract should set forth what is and is not covered in detail (in addition, there would be a short summary version). They probably don't have to provide procedure codes that are covered or not covered because no such one to one correspondence exists because the language of the insurance contract is controlling and does not exactly correspond to procedure codes. For example, one of the basic eligibility questions is whether a procedure is medically necessary. A procedure may be medically necessary for one person, but not for another, and usually a denial based upon medical necessity is subject to appeal to other medical professionals engaged by the insurance company. Unless the insurance contract provides that an EOB must contain procedure codes, it probably doesn't have an affirmative obligation to do so, because there is no general principle of law that would require them to disclose their internal classification of services provided outside of a litigation context. And, in a litigation context, you probably could obtain procedure codes in discovery from the insurance company, as the code assigned to a procedure on an EOB would almost surely not be privileged or a legally protected secret. It may very well be that the company has an in house set of procedures for certain common diagnosis codes that are routinely allowed or are flagged for review by an insurance company bureaucrat. But, that would ordinarily be considered something of a trade secret of the company and is not a statement of what is or is not allowed under the actual health insurance contract. However, the privilege against disclosing the information in that context would flow from trade secret law and not from the fact that they are PHI. I don't agree that PHI is the correct reason for failing to disclose that information (unless some case law of which I am not aware has interpreted it differently). The federal law definition of PHI is at 45 CFR 160.103: Protected health information means individually identifiable health information: (1) Except as provided in paragraph (2) of this definition, that is: (i) Transmitted by electronic media; (ii) Maintained in electronic media; or (iii) Transmitted or maintained in any other form or medium. (2) Protected health information excludes individually identifiable health information: (i) In education records covered by the Family Educational Rights and Privacy Act, as amended, 20 U.S.C. 1232g; (ii) In records described at 20 U.S.C. 1232g(a)(4)(B)(iv); (iii) In employment records held by a covered entity in its role as employer; and (iv) Regarding a person who has been deceased for more than 50 years. The cross reference to 20 U.S.c. 1232g(a)(4)(B)(iv) reads as follows: (iv) records on a student who is eighteen years of age or older, or is attending an institution of postsecondary education, which are made or maintained by a physician, psychiatrist, psychologist, or other recognized professional or paraprofessional acting in his professional or paraprofessional capacity, or assisting in that capacity, and which are made, maintained, or used only in connection with the provision of treatment to the student, and are not available to anyone other than persons providing such treatment, except that such records can be personally reviewed by a physician or other appropriate professional of the student’s choice. In short, it is B.S. that you are being given an illegitimate reason for not complying with your request, but it is probably still within the company's rights for other legitimate reasons to deny your request.
This practice is known as "rescission". It is legal under 45 CFR §147.128 in some circumstances. The regulation says (a) A group health plan, or a health insurance issuer offering group or individual health insurance coverage, must not rescind coverage under the plan, or under the policy, certificate, or contract of insurance, with respect to an individual (including a group to which the individual belongs or family coverage in which the individual is included) once the individual is covered under the plan or coverage, unless the individual (or a person seeking coverage on behalf of the individual) performs an act, practice, or omission that constitutes fraud, or makes an intentional misrepresentation of material fact, as prohibited by the terms of the plan or coverage. The law also prohibits surprises: A group health plan, or a health insurance issuer offering group or individual health insurance coverage, must provide at least 30 days advance written notice to each participant (in the individual market, primary subscriber) who would be affected before coverage may be rescinded under this paragraph (a)(1), regardless of, in the case of group coverage, whether the coverage is insured or self-insured, or whether the rescission applies to an entire group or only to an individual within the group. (The rules of this paragraph (a)(1) apply regardless of any contestability period that may otherwise apply.) Note that the regulation pertains to insurance plans, and not employers. The employer may in good faith believe that you are stuck with the medical bills, but their opinion does not matter as far as this regulation goes. However, the employer also does not have the right to "declare" on behalf of the insurance company that your wife was covered. If you assume that she had coverage because the employer (mistakenly) said you did, but there was actually no coverage, then that is between you and the employer, or possibly you and the doctor. A prior question is whether she was actually covered in that past period. The contract between the insurance company and the employer might hypothetically state that only employees are covered, and may have accidentally submitted enrollment information with mistaken information ("X is an employee"). Since there was no intentional misrepresentation (we assume), coverage cannot be rescinded. Also note that rescission is retroactive cancelling, not prospective cancelling ("henceforth, you are not covered").
There is no state that requires you to show ID to obtain medical care. To the extent that this is done it is done at the behest of whoever is paying for the care to determine that you are someone who is authorized to benefit from this payment, and not an imposter, or as a matter of policy of the doctor. (An exception to this general rule applies when one wants to pick up a prescription for a controlled substance or a Sudafed product, where you must indeed show ID to show that your name matches a prescription or to insure that the right name is entered into the Sudafed database.) It might be more convenient for the doctor in terms of collection of bad debt, insurance policy claims (where an insurance card would normally be required, at least), protection against fraud claims from an insurer, and medical record keeping to have a name, so a doctor might make it a policy to require ID, but it is not required by law (except where a government benefit provider like Medicaid or Medicare is involved and has a regulation requiring it). For example, in the Las Vegas shooting, where there wasn't time to process paperwork, hospital triage officials simply assigned an alias to every incoming patient and wrote it in marker on their body to keep the medical records straight, and to allow that alias to track medical costs to be billed when the time came to get the proper intake paperwork filled out and the file sent to the accounting department. There are also other circumstances that do not involve emergency treatment (e.g. STD testing, methadone treatment at free clinics, and clinical trials) where an alias rather than a true name is sometimes used to keep track of patients.