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PREVENTING OVERPAYMENTS FROM BECOMING FALSE CLAIMS

By:  Andrew Sparks Overpayments to healthcare providers receiving Medicare reimbursements are at risk of civil and criminal enforcement action if not attuned to a particular reimbursement rule and diligent in compliance with the rule’s requirements. In short, the overpayment rule turns potential billing mistakes into fraud. A healthcare provider cannot keep money paid in error. The Government and relator bar are certain to address fully this theory of liability against every healthcare provider who ends up in litigation. If an overpayment is identified and the provider does nothing, then the provider will end up paying significantly more to the Government. It’s the proverbial pay (less for compliance) now or more (to the Government) later. Put differently, healthcare providers should address the smaller problem sooner rather than the bigger problem later.  Last year Centers for Medicare and Medicaid Services (CMS) released its Final Rule concerning overpayment procedures for Medicare Parts A and B. The Rule implements Section 6402(a) of the Affordable Care Act, which addresses the identification, reporting and repayment of overpayments. Healthcare providers reasonably should expect to see increased use of this provision in Government enforcement and whistleblower lawsuits now that the overpayment requirements have been disseminated fully throughout the healthcare community.  Last year Centers for Medicare and Medicaid Services (CMS) released its Final Rule concerning overpayment procedures  for Medicare Parts A and B. The Rule implements Section 6402(a)...

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Health System Paid $2.4 Million Settlement After Identification in a Press Release of a Patient Who Was Engaged in Fraud

By: Kimberly Ruppel The U.S. Department of Health and Human Services Office for Civil Rights (“OCR”) announced a $2,400,000 settlement with Memorial Hermann Health System (“MHHS”) to resolve an investigation of an unauthorized disclosure of protected health information (“PHI”) as a potential violation of the Privacy Rule of the Health Insurance Portability and Accountability Act (“HIPAA”).  In addition to payment of the settlement, MHHS agreed to enter into a Corrective Action Plan with provisions for training and documenting compliance efforts.   MHHS is the largest not-for-profit health system in southeast Texas, consisting of 13 hospitals, 8 cancer centers, 3 heart and vascular institutes and 27 sports medicine and rehabilitation centers, and employs approximately 24,000 people.   In September 2015, a patient at one of MHHS’s clinics presented an allegedly fraudulent identification card to office staff.  The staff person alerted appropriate authorities and the patient was arrested.  So far, there was no violation of HIPAA because the staff person was disclosing PHI in furtherance of permissible law enforcement efforts. Where things began to go awry for MHHS was the initial publication of a press release identifying the patient by name in the title of the release, which was issued to fifteen media outlets and/or reporters.  MHHS further compounded its error by disclosing the patient’s name during three meetings with an advocacy group, state representatives, and a state senator.  To make matters worse,...

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Key Tax Changes in the American Health Care Act

By: Cyndi Moore  The American Health Care Act (“AHCA”), passed by the House of Representatives on May 4, 2017, repeals many of the taxes added by the Affordable Care Act (“ACA”) and makes changes to other tax rules.  Some of the notable changes proposed to be made to the Internal Revenue Code are:             1.         The individual mandate to maintain health insurance and the employer mandate to offer health insurance remain in the Code, but the taxes are “zeroed out” effective retroactively to 2016.               2.         The following taxes, fees, credits and limitations are repealed as of the year shown below:   ·         The net investment income tax (NIIT) (2017) ·         The 0.9% additional Medicare tax (2023) ·         The small employer health insurance credit (2020) ·         The $2500 limitation on contributions to a health flexible spending account (FSA) (2017) ·         The annual fee on branded prescription drug sales (2017) ·         The medical device excise tax (2017) ·         The annual fee on health insurance providers (2017) ·         The elimination of a deduction for expenses allocable to the Medicare Part D subsidy (2017) ·         The 10% tanning salon tax (June 30, 2017)             3.         The “Cadillac” tax on high cost health plans is delayed until 2026.              4.         Individuals may be reimbursed for over-the-counter medications under a health savings account (HSA), health FSA or a health reimbursement arrangement (HRA) (2017).              5.        ...

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Practicing Telemedicine Across State Borders: New Expedited Licenses Permit Physicians to Expand Practice

By: Marki Stewart In a watershed moment for the expansion of telemedicine, the Interstate Medical Licensure Compact Commission is now processing applications to allow physicians to practice telemedicine across state lines with greater ease.  Nineteen states have passed legislation to adopt the Interstate Medical Licensure Compact, which allows physicians to obtain a license to practice medicine in any Compact state through a simplified application process.  Under the new system, participating state medical boards retain their licensing and disciplinary authority, but agree to share information essential to licensing, creating a streamlined process. The Federation of State Medical Boards’ President and CEO, Humayun Chaudhry, DO, MACP, called the Compact a “milestone” for medical regulation in the United States.  “The launch of the Compact will empower interested and eligible physicians to deliver high-quality care across state lines to reach more patients in rural and underserved communities. This is a major win for patient safety and an achievement that will lessen the burden being felt nationwide as a result of our country’s physician shortage.” States currently participating in the Compact are Idaho, Montana, Wyoming, Nevada, Arizona, Utah, Colorado, South Dakota, Kansas, Minnesota, Iowa, Wisconsin, Illinois, Mississippi, Alabama, West Virginia, Pennsylvania, New Hampshire, and Nebraska.  Seven additional states have proposed legislation to adopt the Compact, including Washington, D.C. Most states require a physician to obtain a license to practice medicine in each state where...

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Wireless Healthcare Services Provider’s $2.5m Settlement Demonstrates Why Understanding HIPAA Requirements Is a Must

By:  Sara Jodka The U.S. Department of Health and Human Services Office for Civil Rights (OCR) announced a $2.5 million Health Insurance Portability and Accountability Act of 1996 (HIPAA) settlement with CardioNet, which is a company that provides remote mobile monitoring of and rapid response to patients at risk for cardiac arrhythmias. The settlement is based on CardioNet’s impermissible disclosure of unsecured electronic protected health information (ePHI).   This settlement is noteworthy for two reasons. First, the monetary size of the settlement figure, which is $2.5 million, is staggering. Second, it is the first settlement involving a wireless healthcare services provider.  The circumstances that led to the settlement are that in January 2012, CardioNet reported to OCR that an employee’s laptop, which contained the electronic protected health information (ePHI) of individuals, was stolen from the employee’s car. OCR’s investigation showed that CardioNet had insufficient risk analysis and risk management processes in place when the ePHI was stolen. The investigation also revealed that CardioNet’s policies and procedures designed to meet the standards of the HIPAA Security Rule had not been implemented at the time of the theft and were only in draft form. CardioNet was also unable to show OCR it had adopted any final policies or procedures regarding the implementation of safeguards for ePHI, including any for mobile devices.  As we have written about before, mobile devices and healthcare employees that...

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The Health Law Blog is published by Dickinson Wright PLLC to inform the public of important developments within the firm and practice areas. The content is informational only and does not constitute legal or professional advice. We encourage you to consult a Dickinson Wright attorney if you have specific questions or concerns relating to any of the topics covered in this blog.

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