Showing 50 posts in Providers.
DOJ Memo: Corporate Investigations to Focus on Individual Accountability
Recent guidance issued by the U.S. Department of Justice (“DOJ”) reveals the government’s renewed focus on individual accountability during corporate investigations. On September 9, 2015, Deputy U.S. Attorney General Sally Quillian Yates issued a memorandum to DOJ attorneys (the “Yates Memo”) that emphasizes the importance of seeking accountability from the individuals who are responsible for corporate wrongdoing.
The Yates Memo outlines six measures that should be taken by federal prosecutors during any investigation of corporate misconduct in order to hold accountable the individuals who are responsible for the conduct. A discussion of each measure appears below. Read More ›
Categories: Fraud & Abuse, Providers
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Quality vs. Quantity: Accountable Care Organization Results Keep Coming, as Does Some Criticism
One of the primary ways that the Affordable Care Act seeks to reduce health care costs is through the formation of Accountable Care Organizations (ACO). ACOs are still a relatively new concept in the healthcare world, as they emerged in 2011 as a result of an initiative by the Centers for Medicare & Medicaid Services (CMS).
ACOs are generally groups of doctors, hospitals, and other health care providers, who voluntarily join forces for the purpose of providing coordinated care to Medicare patients (see other Foster Swift articles on ACOs). ACOs were established as a means of coordinating care in order to ensure that patients, especially the chronically ill, receive effective care while avoiding unnecessary duplication of services and preventing medical errors. ACOs that achieve cost saving from providing timely and accurate care that meet quality benchmarks share in Medicare savings. In short, ACOs are intended to encourage quality of care, not quantity of care, and ACOs that deliver care more efficiently are eligible for bonuses. Read More ›
Categories: Accountable Care Organizations, Health Care Reform, Medicare/Medicaid, News & Events, Providers
CMS Issues Final Rules for Fiscal Year 2016 Provider Payments
On July 31, 2015, the Centers for Medicare & Medicaid Services (“CMS”) issued final Medicare payment rules for federal fiscal year 2016 (the “Rules”). The Rules affect hospitals, hospices, psychiatric facilities, and rehabilitation facilities. Read More ›
Categories: Billing/Payment, Medicare/Medicaid, News & Events, Providers
HHS Issues HIPAA “Basics” Fact Sheet
The Department of Health and Human Services (“HHS”) recently released a HIPAA overview called “HIPAA Basics for Providers: Privacy, Security, and Breach Notification Rules” (the “Overview”). The Overview is intended to provide HIPAA Covered Entities such as physicians, hospitals, and other health care providers with a basic overview of HIPAA’s rules and responsibilities. The fact sheet also provides an overview to Business Associates (such as law firms and accounting firms who receive protected health information ("PHI") from Covered Entities). The Overview can be found here.
The Overview explains that the HIPAA Privacy Rule protects individually identifiable PHI, which includes information such as an individual’s past, present, or future physical or mental health condition. Read More ›
Categories: HIPAA, News & Events, Privacy, Providers
Government Intervenes in Affordable Care Act 60 day Rule Violation Allegation
In 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
Tuomey Health Loses Appeal, Facing $237 Million in Fees and Damages
A very long legal battle may be nearing its final chapter after the U.S. Court of Appeals for the Fourth Circuit upheld a $237 million judgment against Tuomey Healthcare System in South Carolina. The judgment is an enormous sum for the regional health system and hospital, with even one of the Court of Appeals judges calling it a "death sentence." A three-judge panel heard the case at the Court of Appeals, so Tuomey could still seek reconsideration from all the judges of that Court or take the case to the U.S. Supreme Court. It may also opt to find a new partnership to keep the hospital afloat. Read More ›
Categories: Compliance, News & Events, Physicians, Providers
New Legislation Makes Concierge Medicine a Viable Business Model In Michigan
The Affordable Care Act ("ACA") authorizes the innovative payment model referred to as direct primary care, and more commonly known as “concierge medicine.” Under the direct primary care model, patients can access comprehensive coverage of basic healthcare services for a flat monthly fee. Such services generally include guaranteed same-day or next-day visits with no waiting times. Concierge medicine is becoming increasingly popular in states where it is allowed. Read More ›
Categories: Billing/Payment, Health Care Reform, Insurance, Providers
The Updated April 2015 National Practitioner Data Bank Guidebook has been Released
The DHHS Health Resources and Services Administration (“HRSA”) has finally published the new National Practitioner Data Bank (“NPDB”) Guidebook. The original Guidebook had not been updated since September 2001.
The updated April 2015 NPDB Guidebook is available here.
The new Guidebook extensively covers the changes resulting from the 2013 merger of the NPDB and the Healthcare Integrity and Protection Data Bank (“HIPDB”). The HIPDB was a separate data bank that received and disclosed reports of final adverse actions by federal and state agencies and health plans against practitioners, entities, providers, and suppliers. After the merger, there were significant changes in the entities eligible to query and report, as well as the individuals and entities subject to reports. Read More ›
Categories: Criminal, Hospitals, Licensing, News & Events, Physicians, Providers
“Top 10 Healthcare Law Trends in 2015” – Part 2
The February issue of the American Health Lawyers Association’s AHLA Connections features a list of the top ten issues that will impact healthcare law in 2015. We summarized the first five topics in a previous blog. (Miss our summary of the first five? Please click here.)
Here are the remaining trends to think about: Read More ›
Categories: Health Care Reform, HIPAA, Medicare/Medicaid, News & Events, Providers
Federal Health IT Coordinator Signs Off on 2017 Interoperability Road Map
The Office of the National Coordinator for Health IT (ONC) released a report on January 29 that identifies optimal healthcare information exchange and implementation standards to enable a nationally interoperable health data information exchange system by 2017 (i.e. standards so that you can have your health records sent and read by all your doctors).
In healthcare, interoperability of IT systems allows providers to share data among different practitioners, insurers, billing and scheduling systems and health information exchanges. Interoperability has the potential to improve the quality of patient care by providing access to accurate, timely information in one location, save time previously used searching for information, and make critical medical information instantly available for clinical decisions.
Under the 2009 economic stimulus legislation’s electronic health records (EHR) incentive payment program, the ONC was directed to establish a governance mechanism for the nationwide health information network. Since that time, however, the ONC has been under increasing criticism about the lack of interoperability of EHRs despite the significant public investment. Read More ›
Categories: Accountable Care Organizations, Electronic Health Records, Providers
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Best Lawyers® 2021
Congratulations to the attorneys of the Health Care practice group at Foster Swift Collins & Smith, PC for their inclusion in the Best Lawyers in America 2021 edition. Firm-wide, 44 lawyers were listed. Best Lawyers lists are compiled based on an exhaustive peer-review evaluation and as lawyers are not required or allowed to pay a fee to be listed; inclusion in Best Lawyers is considered a singular honor. Health Care practice group members listed in Best Lawyers are as follows:
- Jennifer B. Van Regenmorter, Holland
To see the full list of Foster Swift attorneys listed in Best Lawyers 2021, click here.