The OIG Addresses Free Patient Transportation Issues

van

vanBy: Jacqueline Bain

The issue of whether a medical provider can provide free patient transport is one that we are asked to look into a few times every year. Aside from the liability issues that it raises, it is one that we have never been able to justify from an Anti-Kickback and Patient Brokering perspective.  The fact is, even given the good intentions of most providers to allow their patients easier access to healthcare, transporting patients to and from your facility or practice is providing them with something of value in return for coming to see you.  However, under slightly different facts than we are usually asked to consider the question, last week, the Department of Health and Human Services Office of the Inspector General (“OIG”) came to a different conclusion.

The OIG issued an advisory opinion upon the request of a hospital system who had asked whether it could provide free transportation to persons who had limited access to public transportation to access the hospital’s facilities. The hospital system offered that the town had inadequate and infrequent public transportation services which would act as a barrier to healthcare for local residents.  The hospital system offered the following facts for consideration:Continue reading

Addiction Treatment is a Story in Search of a Villain

Compliance With Laws & Regulations

healthcare business

Hastiness and superficiality are the psychic diseases of the twentieth century, and more than anywhere else this disease is reflected in the press— Alexander Solzhenitsyn

By: Jeff Cohen

I read an article in a local paper the other day.  It was about (a) a guy who owned a treatment center (who has not been charged with committing a crime), (b) a lawsuit filed by a large insurance company against a toxicology lab that the insurer owes millions, and (c) the fact that insurance companies pay a lot for toxicology lab testing.  I scratched my head, wondering how there was anything newsworthy there.  The “story” being sold by the paper, however, created a story with a villain (the providers of services to people in recovery from drug and alcohol addiction) and a “victim” (people receiving care for addiction).  I can’t resist responding.

There’s a difference between something that’s interesting and worthy of comment vs. a journalistic attempt to concoct controversy and intrigue that people might buy.  There’s not much of the former, but a lot of the latter.  People in recovery being victimized by horrible, greedy people is an interesting story.  Unfortunately, it’s off the mark and really not helpful to anyone.

There are three pretty safe assumptions we can almost all agree on:  first, there are a lot of people who want to live life without active addiction.  Second, many of them think they need help to create a better life.  Third, some providers of help to people in recovery make a bunch of money providing that service.Continue reading

Avoiding Delays in License Renewals

Florida Medical Board

Florida Medical BoardIt’s almost renewal time once again for many health care practitioners.  If this is your renewal cycle, please note the following information provided by the Florida Board of Medicine, which can help you avoid some of the most common delays encountered with license renewals.

It is important to remember the upcoming renewal is the first to have mandatory continuing medical education reporting requirements.  If you have not done so, please activate your account with CE Broker and ensure that all required CME you have completed for this renewal has been uploaded.

Most of the medical practitioners renewing will be required to submit the following:

  • Completed renewal application
  • Required fees
  • Evidence that you have practiced medicine or have been on the active faculty of an accredited medical school for at least two years of the immediately preceding four years
  • Completion of Financial Responsibility form
  • Completion of Physician Workforce Survey
  • Verification of Physician Profile
  • Verification of your current status relating to prescribing controlled substances for the treatment of chronic non-malignant pain

Continue reading

Florida Recovery Residences on the Chopping Block

gavelTwo separate legislative proposals are aimed to tighten up the sober home industry.  The Bills follow on the heels of legislation proposed last year, which did not become law.  We have a couple weeks left till the Legislative session ends (May 1st), after which time we will see what regulation made its way through the process.  Until then, it’s important to have an idea of what is on the horizon.

Committee Substitute for House Bill 21 and Committee Substitute for Senate Bill 326 contain the following interesting features—

Creates “voluntary” certification for recovery residences;

A. Specifies the requirement of a “recovery residence administrator;”

B. Specifies that the credentialing entity of both the recovery residence and the recovery residence administrator will be a nonprofit organization (not necessarily one that is tax exempt) that “develops, administers professional, facility, or organization certification programs according to applicable nationally recognized certification or psychometric standards,” and requires the credentialing entity to:

  • Establish the recovery residence certification requirements. Interestingly, the Legislature, which states that those in recovery are vulnerable and need to be protected, is offloading to an unspecified nonprofit organization (which anyone can form in five minutes) the responsibility for developing certification requirements;
  • Establish procedures to, among other things, to monitor, inspect and insure compliance with the certification requirements established by this unspecified nonprofit organization entrusted by the state of Florida with this responsibility;
  • Require recovery residences (who are volunteering to be regulated) to submit documents such as job descriptions, drug testing procedures and requirements, to be managed by a “certified recovery residence administrator.”

The Bill also states that a recovery residence cannot be certified if an owner, director or CFO plead guilty, no contest or was found guilty of certain offenses.  Moreover, the non-governmental, not for profit certifying body has authority to suspend or revoke a certification if the entity determines the residence isn’t complying with the law.  No due process is required.  Oh, and finally, as of July 1, 2016, a provider licensed under Chapter 397 may not refer a patient (current or discharged) to a recovery residence unless the residence, which is not required to be certified, actually becomes certified, making the voluntary certification requirement, ummm….mandatory!Continue reading

Protecting Your Practice Through Restrictive Covenants

Contract CW

Contract CWBy: Charlene Wilkinson

The beginning of a new year is a great time to evaluate your medical practice and determine ways to protect its healthy growth for the future.  The time, effort and dedication that it may take to build a successful practice may be quickly undermined without certain contractual protections in place.   As you seek to establish or expand your practice, it is essential to protect your hard earned efforts from employees and consultants taking a portion of your patient base, employees and valuable proprietary business processes to compete against you.

One of the ways physicians seek to protect the investment that they have made in their practice is through the use of restrictive covenants. Restrictive covenant is an all-inclusive term used to refer to all contractual restrictions upon competitive practices; nonsolicitation; confidential information and use of trade practices.  Restrictive covenants may be found in a number of documents related to your practice. A restrictive covenant may be found in your practice governing documents, such as the shareholder agreement, the partnership agreement of a partnership or the operating agreement of a limited liability company. A restrictive covenant is often included in an employment contract where it prevents an employee from engaging in certain competitive practices while they are an employee and for a period of time after their employment ends. There may be a restrictive covenant provision in a contract for the sale of a party’s interest in the practice.Continue reading

Breaking Down Legal Buzzwords: Fair Market Value & Commercial Reasonableness

book-stacks-colorful.jpgBy: Jackie Bain

Federal fraud and abuse laws often require that arrangements between health care providers are “fair market value” and “commercially reasonable.” And while these terms look like legalese and are easy to overlook, in fact, they are important. For example, the Federal Stark law requires strict compliance with its terms. A physician may enter into a prohibited arrangement with the intention that it falls within an exception to the law. If, however, the arrangement is not fair market value, the physician’s arrangement would violate the law, subject the physician to fines and risk the physician’s ability to participate in Medicare. Continue reading

Recovery Business Industry Forced to Grow Up Fast

bcbs lawsuitBy: Jeff Cohen

When Horizon Blue Cross/Blue Shield of New Jersey blasted Avee Laboratories in connection with a variety of business practices, some of which included kickback violations (in connection with the provision of POCT cups), businesses in the drug and alcohol recovery space took notice.  With the recent FBI raid on a Palm Beach County sober house and the amped up attention of managed care payers to clinical lab testing, the industry is reeling!  The good news, however, is that these recent developments, along with increased payor scrutiny (and payment denial!), is a call to compliance that has long seemed inapplicable to an industry that has been able for many years to operate with simplicity not found in other segments of the healthcare business community.  Where facilities once viewed DCF as the only regulatory parent they had to please, they are now learning there is a far greater degree of regulatory complexity to be considered; and they are rushing towards compliance.Continue reading

Subpoena Duces What???

By: David W. Hirshfeld

If you run medical practice, you receive subpoenas.  Here are a few tips to help you respond to a common form of subpoena without having to involve your attorney.

The most common form of subpoena is a “Subpoena Duces Tecum.”  A Subpoena Duces Tecum requires the recipient to provide specific records, and the custodian of the records who can answer a few basic questions at a deposition about how the records are generated and kept by the practice.  A deposition is just an interview under oath, conducted by one or more attorneys, that is recorded.  The subpoena will set the date for the deposition.

Depositions are inconvenient, as you will have attorneys in your office for all your patients to see and gossip about, and someone on your staff will have to take time to be the subject of the deposition.  In the vast majority of cases, the attorneys will accept the records by mail if they are accompanied by a written certification signed before a notary.  You see, in order for the records to be useful to the attorneys, they need to know that the records are accurate and complete, were generated and maintained in the ordinary course of the practice’s business, and haven’t been changed in response to the subpoena; and this is what they intend to learn from the deposition.  Most attorneys will accept answers to these questions in a written certification in lieu of an in-person deposition.

When you receive a subpoena duces tecum, you should call the issuing attorney and ask if you can respond to the subpoena via written certification rather than a deposition.  You should call the issuing attorney immediately, as subpoenas are time sensitive and often require speedy compliance.  In addition, if the subpoena was not accompanied by an authorization for release of records signed by the patient, then you should ask the issuing attorney for that authorization as a condition of your compliance with the subpoena.  Never discuss the patient’s treatment with the issuing attorney.

Supreme Court upholds Obama health care law

Via @USAToday

The Supreme Court upheld President Obama’s health care law today in a splintered, complex opinion that gives Obama a major election-year victory.

Basically. the justices said that the individual mandate — the requirement that most Americans buy health insurance or pay a fine — is constitutional as a tax.

Chief Justice John Roberts — a conservative appointed by President George W. Bush — provided the key vote to preserve the landmark health care law, which figures to be a major issue in Obama’s re-election bid against Republican opponent Mitt Romney.

The government had argued that Congress had the authority to pass the individual mandate as part of its power to regulate interstate commerce; the court disagreed with that analysis, but preserved the mandate because the fine amounts to a tax that is within Congress’ constitutional taxing powers.

The announcement will have a major impact on the nation’s health care system, the actions of both federal and state governments, and the course of the November presidential and congressional elections.

A key question for the high court: The law’s individual mandate, the requirement that nearly all Americans buy health insurance, or pay a penalty.

Critics call the requirement an unconstitutional overreach by Congress and the Obama administration; supporters say it is necessary to finance the health care plan, and well within the government’s powers under the Commerce Clause of the U.S. Constitution.

While the individual mandate remained 18 months away from implementation, many other provisions already have gone into effect, such as free wellness exams for seniors and allowing children up to age 26 to remain on their parents’ health insurance policies. Some of those provisions are likely to be retained by some insurance companies.

Other impacts will sort themselves out, once the court rules:

— Health care millions of Americans will be affected – coverage for some, premiums for others. Doctors, hospitals, drug makers, insurers, and employers large and small all will feel the impact.

— States — some of which have moved ahead with the health care overhaul while others have held back — now have decisions to make. A deeply divided Congress could decide to re-enter the debate with legislation.

— The presidential race between Obama and Republican challenger Mitt Romney is sure to feel the repercussions. Obama’s health care law has proven to be slightly more unpopular than popular among Americans.

Full Story Here: http://content.usatoday.com/communities/theoval/post/2012/06/Supreme-Court-rules-on-Obama-health-care-plan-718037/1#.T-xqPhd5F9E