Health Care Law Blog
Programs of All-Inclusive Care for the Elderly (PACE) organizations provide certain medical and social services to eligible individuals who meet the Long Term Care level of care criteria.
The U.S. Department of Health & Human Services ("HHS") Office of Inspector General ("OIG") recently issued a preliminary report regarding quality-of-care concerns at skilled nursing facilities ("SNFs"). The report was issued in connection with the OIG's ongoing review of potential abuse and neglect of Medicare beneficiaries in SNFs.
The Centers for Medicare & Medicaid Services ("CMS") recently announced that they will delay enforcement penalties related to Phase 2 of their revised nursing home Requirements for Participation (commonly referred to in the industry as the "Mega Rule").
Hospice care is intended to help terminally ill beneficiaries continue living with minimal disruptions and to provide support for a beneficiary’s family and caregivers. In a recent report, the Department of Health and Human Services Office of Inspector General (OIG) found that hospices are not always meeting two key coverage requirements for the Medicare hospice benefit: (1) that beneficiaries sign an election statement and (2) that a physician certifies that the beneficiary is terminally ill. The purpose of these requirements is, among other things, to properly inform beneficiaries of the implications of hospice care and to prevent Medicare fraud.
Recently, the Centers for Medicare & Medicaid Services (“CMS”) issued a final rule (“Final Rule”) updating the Medicare Conditions of Participation (“CoPs”) for long-term care (“LTC”) facilities. It is the first time in over 15 years that substantial LTC CoP revisions have been released.
LTC facilities affected by the Final Rule include skilled nursing facilities for Medicare and nursing facilities for Medicaid, or those facilities that are duly certified. The Final Rule took effect on November 28, 2016, however CMS has planned for a phased implementation. LTC providers must complete the three implementation phases by November 28 in the years 2016, 2017 and 2018, respectively. CMS has estimated that the costs of compliance will be $62,900 in the first phase of implementation, and $55,000 per year for phases two and three.
On April 30, 2015, the Centers for Medicare & Medicaid Services (“CMS”) issued a proposed rule that would update fiscal year (“FY”) 2016 Medicare payment rates and the wage index for hospices serving Medicare beneficiaries (the “Proposed Rule”). CMS estimates that the Proposed Rule would result in a 1.3 percent ($200 million) increase in hospice payments for FY 2016. The highlights of the Proposed Rule are summarized below.
On Feb. 4, 2014, new legislation took effect amending Michigan's Do-Not-Resuscitate Procedure Act (the "Act").The Act allows a guardian, who has the power under Michigan’s guardianship laws, to consent to a do-not-resuscitate order (“DNR Order”) on behalf of a legally incapacitated person under certain conditions. This power does not extend to a guardian ad litem.
In 1996, Michigan passed the Act, which permits a competent adult or his or her patient advocate to sign a DNR Order instructing emergency personnel not to perform potentially life-saving procedures in the event of the cessation of respiration and circulation. However, the Act did not give express authority to a guardian acting on behalf of an individual to authorize a DNR Order.
Omnicare Inc., the nation's largest dispenser of prescription drugs in nursing homes, announced on October 23, 2013, that it has agreed to pay $120 million to settle a whistleblower lawsuit alleging kickbacks to nursing homes.
The whistleblower in the case, an Ohio pharmacist named Donald Gale, worked for Omnicare from 1993 until 2010. The lawsuit, filed in federal court in Cleveland in 2010, accused Omnicare of giving discounts for prescription drugs to nursing homes for certain Medicare patients in return for referrals of other patients at higher prices paid for by the federal government.
The National Practitioner Data Bank (NPDB) has published a quick guide to assist hospitals and health care entities in reporting actions that adversely affect clinical privileges held by physicians, dentists and other health professionals.
The guide (We have identified that the following link is no longer active, and it has been removed) lists several “reporting scenarios” and indicates the type of report that may be required (initial adverse action report, revision-to-action report, correction report, or no report). The guide also summarizes the reasons for voiding a previous report (report was erroneously submitted, action was not reportable, or action was reversed or overturned).
The guide is a helpful starting point for a hospital or health care entity that is involved in a privileging action. However, the scope and timing of reporting requirements under the NPDB regulations can be quite complex. Considering the very serious implications from reporting—or not reporting—an adverse privileging action, it would be prudent to only use the guide as a quick reference and not as a decision-making tool.
If you have any questions about the guide, please contact Richard Kraus at 517.371.8104 or by using the email form below.
So far, July has been a busy month for health care fraud enforcement across the country.
On July 18, Divyesh Patel, owner of Alpine Nursing Care Inc. in North Randall, Ohio, was sentenced to two years in prison after pleading guilty to one count of conspiracy to commit health care fraud and four counts of health care fraud. Patel was also ordered to pay total restitution of $1,939,864 to the Medicaid Program in Ohio. According to court documents, Patel hired Belita Mable Bush as the office manager despite knowing that Bush had been convicted of a health care-related felony and excluded from involvement in billing federal health care programs. From June 1, 2006 to October 18, 2009, Patel conspired with Bush to defraud Medicaid by billing for services that had never been performed or that had been performed by excluded individuals. The conspiracy resulted in losses of approximately $1.9 million to the Medicare and Medicaid programs. Bush was convicted on similar charges and will be sentenced next month.
In 2008, the Michigan Supreme Court concluded that domestic partnership policies intended to provide health care benefits to same sex couples violated Michigan law. Specifically, National Pride at Work v Governor held that such policies violated the Michigan Marriage Amendment (“Marriage Amendment”) by recognizing same sex domestic partnerships as analogous to a marriage or similar union. (The Marriage Amendment recognizes the union of one man and one woman as the only agreement recognized as a marriage and also prohibits public employers from providing health insurance benefits to their employees' same-sex domestic partners.)
The Office for Civil Rights of the Department of Health and Human Services recently released its final rule (the "Rule") modifying the Health Insurance Portability and Accountability Act ("HIPAA") and implementing the statutory requirements of the Health Information Technology for Economic and Clinical Health Act (“HITECH”). (The Rule was originally expected to be released in February of 2010 when HITECH became effective.) In short, the Rule: modifies HIPAA’s privacy, security and enforcement rules; changes HIPAA’s enforcement rules to increase penalties consistent with HITECH; provides a final rule on breach notification; and modifies HIPAA as required by the Genetic Information Nondiscrimination Act.
The new rule is approximately 563 pages and can be accessed here. If you have any questions about how the Rule may impact your health care practice, please contact Nicole Stratton at (517) 371-8140 or by using the form below.
Foster Swift lawyers were well represented at the Annual Meeting of the State Bar of Michigan's Health Care Law Section held on September 19th. Gilbert Frimet, Gary McRay, Jennifer Kildea Dewane, and Nicole Stratton, members of Foster Swift Health Care Law Practice Group, all traveled to Detroit to attend the meeting.
Governor Rick Snyder in a press conference this morning proposed a total overhaul of Blue Cross Blue Shield of Michigan ("BCBSM"). Governor Snyder's proposal would:
- covert BCBSM to a non-profit mutual company;
- end its tax exemption; and
- remove Attorney General review of requested rates.
In essence, Michigan would treat BCBSM as it would any other health insurer as BCBSM would be regulated by the Insurance Code. While this proposal may seem drastic, it is not surprising given recent regulation orders by the Office of Financial and Insurance Regulation ("OFIR") curtailing BCBSM's use of most favored nation clauses ("MFN Clauses") and rejecting the low rates that it charges to hospitals and other providers.
On August 17, 2012, the Department of Justice (“DOJ”) and the Federal Trade Commission (“FTC”) announced that they will hold a joint public workshop addressing insurers’ use of most-favored-nation clauses (“MFNs”). The all-day workshop will be held on September 10, 2012 in Washington DC and will be in-person, free and open to the public. At the workshop, the agencies intend “to explore the use of MFN clauses and the implications for antitrust enforcement and policy.” The workshop will also include a series of panel discussions examining the legal treatment of MFNs, the economic theories concerning MFNs, and their impact upon the health care industry.
The Health Information Technology for Economic and Clinical Health Act ("HITECH Act"), passed in 2009, imposed new requirements on health care providers (among others) related to the privacy and security of Protected Health Information ("PHI"). Included in the HITECH Act's requirements was a mandate that the Department of Health and Human Services’ ("HHS") Office for Civil Rights ("OCR") conduct audits to analyze the processes, controls and policies of certain covered entities. The pilot program for such audits began in 2011 and will conclude in December, 2012.
A recent case highlights why a plan sponsor must use caution when agreeing to provide COBRA coverage that extends beyond the maximum COBRA coverage period. The court in Bekaert Corporation v. Standard Security Life Insurance Company of New York, 2011 WL 3568028 (N.D. Ohio) recently held that an employer who offered extended COBRA coverage pursuant to a separation agreement with a particular employee was not entitled to stop-loss coverage. In Bekaert,a retiree received extended COBRA continuation health coverage pursuant to a separation agreement with the employer. The retiree's medical claims were paid under the employer's self-funded health plan and then were submitted for reimbursement under the employer's stop-loss policy as excess loss claims. The stop-loss carrier denied the claims, stating the retiree was not a covered person under the stop-loss policy.
The Michigan House of Representatives and Senate have both recently approved versions of what's been termed the "I'm Sorry Bill." The Bill provides that certain statements expressing sympathy, compassion, commiseration, or a general sense of benevolence relating to pain, suffering, or death of an individual are inadmissible as evidence of an admission of liability in a medical malpractice action. However, statements of fault, negligence or culpable conduct would remain admissible.
The Centers for Medicare and Medicaid Service's (CMS) recently published Final Rule related to Civil Money Penalties for Nursing Homes implements provisions of the Patient Protection and Affordable Care Act related to the nursing home enforcement process.
The Centers for Medicare & Medicaid Services ("CMS") has recently proposed the much anticipated Long Term Care regulations related to Hospice Services. These proposed rules mirror the hospice regulations that went into effect on December 2, 2008, and establish requirements that facilities must meet in order to qualify to participate in the Medicare and Medicaid programs. Specifically, the proposed rules obligate Long Term Care facilities to (1) enter into an agreement with a Medicare-certified hospice to arrange for the provision of hospice services to residents, or (2) assist in transferring residents to a facility that will arrange for the provision of hospice services when requested by the residents. If an arrangement between a Long Term Care facility and Hospice is established, CMS has also strictly regulated the content of the agreements between the two. Traditionally, the content of such agreements receives significant attention and scrutiny from surveyors.
If you would like assistance in drafting new agreements or reviewing your current contracts to ensure compliance with the proposed rules, please contact one of the experts in Foster Swift's Health Care Practice Group.
In conjunction with a step-up in other fraud and abuse enforcement activities, CMS recently announced new screening procedures, which will be applicable to newly enrolling providers and suppliers as well as to providers and suppliers who are currently enrolled in Medicare, Medicaid and CHIP who revalidate their enrollment information.
