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Showing 66 posts in Hospitals.

Skilled Nursing Facility and Hospice Contracts – Prime Time to Update

Effective November 28, 2016, the Centers for Medicare and Medicaid Services published a final rule which revised the Medicare Conditions of Participation for Long-Term Care Facilities. There are three different phases of implementation. Read More ›

Categories: Contracts, Hospice, Hospitals, Medicare/Medicaid

Update on the Michigan Department of Licensing and Regulatory Affairs Proposed Rules for Licensing Health Facilities and Agencies

Earlier this year, the Michigan Department of Licensing and Regulatory Affairs (LARA) issued proposed administrative rules relating to the licensing of health care facilities. Currently, there are separate sets of rules that apply to each type of health facility, such as hospitals, hospices, and nursing homes. Read More ›

Categories: Compliance, Health Care Reform, Hospice, Hospitals, Licensing, Regulations

Updates to the Confidentiality of Substance Use Disorder Patient Records Regulations

Earlier this year, the Substance Abuse and Mental Health Services Administration (SAMHSA), a branch of the U.S. Department of Health and Human Services (HHS), finalized updates to the Confidentiality of Substance Use Disorder Patient Records regulation at 42 CFR Part 2 ("Part 2"). Read More ›

Categories: Electronic Health Records, HIPAA, Hospitals, Physicians, Providers

IRS Revokes Hospital's Tax-Exempt Status for Noncompliance with Affordable Care Act

Earlier this year, the Internal Revenue Service (IRS) revoked the tax exempt status of an unidentified hospital for failing to comply with the Affordable Care Act (ACA). Read More ›

Categories: Health Care Reform, Hospitals, Tax

DOJ Starts Cracking Down on Individual Health Care Executives for False Claims Act and Stark Law Violations Committed by Their Companies

Healthcare executives and physicians take note: The Department of Justice is now cracking down on individuals, and not just companies, for False Claims Act, Stark law, and anti-kickback statute violations. Read More ›

Categories: Hospitals, Medicare/Medicaid, News & Events, Physicians

OCR Begins Phase 2 Audit Program of Covered Entities and Business Associates

AuditThe U.S. Department of Health and Human Services (HHS) Office for Civil Rights (OCR) recently announced that it has begun Phase 2 of its HIPAA audit program. This audit phase will impact covered entities and their business associates. Read More ›

Categories: Compliance, HIPAA, Hospitals, Providers

CARE Act Legislation Signed Into Law By Governor Snyder and Set to Take Effect July 12th

care act legislationThe Michigan CARE Act, recently signed into law by Governor Snyder, is set to take effect on July 12, 2016. Michigan becomes the 29th state to enact the CARE Act, which is intended to support and equip family caregivers with information and training when loved ones go into the hospital and as they transition home. A copy of Public Act No. 85 is available here. Read More ›

Categories: Compliance, Hospitals, News & Events

Is Losing Money by Employing Physicians a Stark Violation?

losing money by employing physiciansModern Health Care has reported that hospitals often lose approximately $176,000 a year per each employed physician.

While this initially seems like a surprising statistic, it is understandable that hospitals lose money when they employ physicians. Physicians in private practice often pay their staff less than comparable hospital employees. When a hospital buys a physician’s practice, the benefit costs typically increase if the staff receives the hospital’s fringe benefit package. Moreover, hospital overhead is typically higher than a private physician practice with regard to HR costs and other support services.

Many systems claim that the only way to manage the health of a given population (which is what ACO and other similar payment structures are requiring) is to be fully integrated with employed physicians, so covering the losses incurred by employing physicians is the necessary cost of preparing for the new paradigm. The ugly, and legally problematic, truth is that most health systems look beyond the income generated by physicians for treating patients but also at income from physician ancillary referrals to justify the economic losses caused by acquiring physician practices. This raises concerns under the Stark law. Read More ›

Categories: Billing/Payment, Compliance, Hospitals, Medicare/Medicaid, Physicians

Government Intervenes in Affordable Care Act 60 day Rule Violation Allegation

Government Intervenes in Affordable Care Act 60 day Rule Violation AllegationIn a first-of-its-kind and closely followed case, a U.S. district court denied a New York health system's (Healthfirst’s) motion to dismiss the U.S. government's and State of New York's complaints in intervention under the federal False Claims Act (FCA) and New York state counterpart. This case represents the first time that the government has intervened in an FCA case based upon an allegation that a party violated the "60 day rule." The 60 day rule came into existence with the passage of the Affordable Care Act (ACA) in 2010 and subjects parties to FCA liability for failing to report and refund an overpayment within 60 days of identification, even if the defendant received the payment through no fault of its own.

The case, Kane ex rel. United States et al. v. Healthfirst et al., involves three hospitals that were part of the Healthfirst health system network and provided care to patients that were part of Healthfirst's Medicaid managed care plan. Healthfirst received payments from the New York State Department of Health (DOH) in return for services provided to Medicaid eligible enrollees.

The government's allegations stem from overpayments to Healthfirst as a result of a software glitch. Healthfirst was first questioned about the possible overpayments by the New York State Comptroller's office in 2010. The health system tasked Kane, an employee and the eventual whistleblower in the case, to look into the payments. Five months later Kane emailed Healthfirst management a spreadsheet listing over 900 claims totaling more than $1 million that contained an erroneous billing code that may have led to the overpayments. Read More ›

Categories: Billing/Payment, Fraud & Abuse, Health Care Reform, Hospitals, Medicare/Medicaid, News & Events, Providers

DOJ and State of Michigan Bring Antitrust Lawsuit Against Four Michigan Hospitals Three Settle Charges Immediately and One Vows to Fight

DOJ and State of Michigan Bring Antitrust Lawsuit Against Four Michigan Hospitals Three Settle Charges Immediately and One Vows to FightThe U.S. Department of Justice (“DOJ”), together with the Michigan Attorney General (“AG”), recently filed a lawsuit alleging that four hospital systems located in Southern Michigan violated antitrust laws by agreeing not to compete with one another.

The civil lawsuit was filed in the U.S. District Court for the Eastern District of Michigan and alleged that the four hospitals agreed not to market or advertise themselves in each others’ territories, which constitutes “unreasonable restraints of trade that are per se illegal” under the Sherman Act and the Michigan Antitrust Reform Act. Read More ›

Categories: Hospitals, News & Events