Showing 50 posts in Providers.
Michigan Allowed to Move Dual Eligibles to Managed Care
Approximately 9 million people in the United States are covered by both Medicare and Medicaid, including seniors with low income and younger people with disabilities. These so-called "dual eligibles" often have complex and costly health needs, and lawmakers have been seeking ways to reduce costs while maintaining and improving care for this segment of the population. Traditionally, coverage and care for dual eligibles has tended to be fragmented and expensive given the challenges posed by separate entities (Medicare and Medicaid) with separate coverage policies.
A number of states, including Michigan, have been working with the Centers for Medicare and Medicaid Services (CMS) to develop proposals to address these challenges, based on new authority in the Affordable Care Act. Through this initiative, 15 states were granted federal funding to help them better coordinate care for dual eligibles. Each of the states, including Michigan, was awarded up to $1 million to help develop new strategies and programs addressing these challenges. Read More ›
Categories: Health Care Reform, Insurance, Medicare/Medicaid, Providers
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Obama Administration Makes Changes to Medicare to Accommodate Same-Sex Marriages
On Thursday, April 3, 2014, the Obama administration announced that it was taking steps to bring its Medicare rules in line with the United States Supreme Court's ruling in US v. Windsor. Specifically, the Department of Health and Human Services (“HHS”) announced that same-sex marriages would be recognized for determining Medicare entitlement and eligibility. Read More ›
Categories: Employee Benefits, Insurance, Medicare/Medicaid, Providers
Upcoming changes in the investigation and discipline of licensed health care professionals
Have you heard? Gov. Snyder signed four bills significantly changing the procedure for investigating and disciplining licensed health professionals under the Public Health Code on April 3. The four statutes take effect on July 1, 2014.
These important changes make it even more crucial for a health professional to consult with legal counsel experienced with the disciplinary process whenever he or she is contacted by the Bureau of Health Care Services (BHCS).
Learn more about the changes. Read the article here.
Categories: Licensing, Physicians, Providers
IT Contract Review
As health care providers continue to increase their use of technology, they are asked more and more frequently to enter into software or other IT contracts. While many health care providers sign these agreements without reviewing them, doing so can create unwanted liability and unexpected problems.
These issues were the topic of a recent State Bar of Michigan Health Care Law Section Webinar entitled “Software Licenses: What You Don’t Know Can Hurt You.” Sam Frederick from Foster Swift was a featured speaker. His presentation discussed important revisions that should be made to software provisions, as well as the consequences for relying on certain boilerplate provisions. In addition, health care providers must require that their software vendors with access to protected health information sign Business Associate Agreements. While many software agreements have business associate-like provisions included in them, they often do not meet all of the required elements under HIPAA. This exposes the health care provider to liability.
In summary, health care providers should have their attorney review any software or IT contracts presented to them and require that their vendors execute Business Associate Agreements. For assistance with this matters, please contact Sam Frederick at (517) 371-8103 or sfrederick@fosterswift.com
Categories: HIPAA, Providers
License Sanctions Against Health Professionals Can Be Used As Evidence in Unrelated Malpractice Cases
Any disciplinary sanction against a health professional’s license can have serious collateral consequences, such as termination from provider networks, loss of malpractice insurance or substantially increased rates, medical staff investigations and proceedings, adverse employment actions, and reports to the National Practitioner Data Bank. A recent Michigan Court of Appeals decision highlights an added risk that many health professionals and their attorneys may not have known. A relatively minor licensing sanction was used, with devastating effect, as evidence in an unrelated malpractice action.
A dentist was sued for malpractice following a root canal procedure in Holder v Schwarcz. The jury awarded $67,500 in damages and the trial court granted $151,555 in case evaluation sanctions. The dentist had been involved in an unrelated licensing investigation relating to root canals for another patient. The licensing action was resolved through a consent order. In a consent order, a health professional does not admit any allegations in the licensing complaint, but agrees that the board’s disciplinary subcommittee may treat them as true and enter a sanction for violating the Public Health Code. The sanction imposed against the dentist in the licensing action included probation for one year, a requirement for ten hours of continuing education, and a $5,000 fine. The sanction was fairly typical for a licensing case alleging negligent care. Read More ›
Categories: Licensing, Physicians, Providers
Health Plans Take Notice: Compliance with HIPAA Administrative Simplification Rules is still Required
On Jan. 2, 2014, the Department of Health and Human Services (“HHS”) issued a proposed rule related to the Administrative Simplification requirements of the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”). Specifically, it delayed the date by which health plans must certify compliance with certain operating rules imposed by the Affordable Care Act (“ACA”).
The ACA required the Secretary of HHS to adopt operating rules related to claims status, eligibility, electronic funds transfers ("EFT") and health care payment and remittance advice transactions ("ERA"). Health plans (and other covered entities) were required to comply with the claims status and eligibility operating rules by Jan. 1, 2013 and the EFT and ERA operating rules by Jan. 1, 2014. Additionally, health plans were required to file a statement with HHS certifying that the health plan is in compliance with the operating rules. This certification statement was due by Dec. 31, 2013. Read More ›
Categories: Billing/Payment, Compliance, Health Care Reform, HIPAA, Insurance, Privacy, Providers
Final Rules Published in the Federal Register Extend Protections of Electronic Health Record Donations
On Dec. 27, 2013, final rules were published in the Federal Register by the Office of Inspector General and the Centers for Medicare & Medicaid Services. These rules amend regulations protecting certain arrangements involving the donation of electronic health records (EHR) software or information technology and training services related to such EHR software from the Anti-Kickback Statute and Stark law. The final rules are nearly identical to one another and make five primary changes to the EHR provisions: Read More ›
Categories: Electronic Health Records, Providers
A Rare Reversal of a Licensing Sanctions by The Michigan Court Of Appeals Offers Hope to Disciplined Health Professionals
A recent Michigan Court of Appeals decision offers a glimmer of hope to health professionals who face the unenviable prospect of appealing adverse decisions made by licensing boards. Since 1994, the Public Health Code has required that appeals by licensed health professionals from adverse licensing decisions be filed in the Michigan Court of Appeals. Over the past two decades, there have been very few cases where the Court of Appeals held that a decision by a licensing board was legally incorrect or factually unsupported. Read More ›
Categories: Licensing, Physicians, Providers
Omnicare Settles Whistleblower Lawsuit Alleging Kickback Scheme With Nursing Homes
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. Read More ›
Categories: Billing/Payment, Fraud & Abuse, Medicare/Medicaid, Pharmacy, Providers
Michigan Senate Approves Medicaid Expansion
The Michigan Medicaid expansion saga has seemingly come to an end, as the Republican-led state Senate narrowly approved Medicaid expansion on Tuesday, August 27 in a 20-18 vote. Eight Republicans joined 12 Democrats to pass a bill that will bring billions of dollars in federal dollars to Michigan to implement a major element of the Patient Protection and Affordable Care Act. Under this bill, approximately 400,000 additional Michigan residents will be eligible for Medicaid coverage.
The vote came after lengthy debate in the Senate on the measure, and passed after "eleventh hour" legislative maneuvering. The Michigan House, which previously passed a Medicaid expansion bill, will likely approve the Senate version of the bill next week. If passed, it will be sent to Governor Snyder's desk for his signature.
Categories: Health Care Reform, Medicare/Medicaid, 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.