Articles and Blogs

On October 31, 2014, the U.S. Department of Health and Human Services Office of Inspector General (“OIG”) released the Work Plan for Fiscal Year 2015 (“Work Plan”). The Work Plan confirms OIG will continue to concentrate a great deal of their enforcement efforts on the security and vulnerabilities of protected health information (“PHI”) contained in…Read More

On October 31, 2014, the Centers for Medicare & Medicaid Services (“CMS”) issued a final notice approving Lake Pointe Medical Center’s (“Lake Pointe”) request for an exception to the Affordable Care Act’s (“ACA’s”) expansion limitations imposed on physician-owned hospitals. Background Under the ACA’s amendments to the Stark Law, a physician-owned hospital cannot expand the aggregate…Read More

Last week, the 11th Circuit Court of Appeals issued its unpublished ruling in US ex rel. Mastej v. Health Management Associates, Inc. At issue was whether the relator’s Third Amended Complaint adequately pled fraud with particularity, as required by Fed.R.Civ.Pro. 9(b). Mastej was an Health Management Associate (“HMA”) executive from 2001 to February 2007. In that role,…Read More

On October 30, 2014, CMS issued its pre-released copy of the Final CY 2015 Home Health Prospective Payment System Rule (“Final Rule”). The Final Rule adopts many of the proposals found in the proposed regulations that were published by CMS earlier this year (“Proposed Rules”). Notably, the Final Rule also contains CMS’s responses to many…Read More

CMS Releases Final Home Health Payment Rule On October 30, CMS released the final rule for the home health prospective payment system for CY 2015. The measure reduces home health payments by 0.3% from 2014 payment levels and is generally consistent with the proposed rule that came out in July. Based on that payment rate, the national…Read More

Senate Enrolled Act 554 from the 2013 legislative session set the stage for an upcoming change in Medicaid policy that will provide reimbursement for certain telehealth services provided by Home Health Agencies (“HHAs”).  The Indiana Health Coverage Programs (“IHCP”) released Bulletin BT201454 earlier this week outlining the policy change that will cover an HHA’s remote monitoring of data related…Read More

In the October 9, 2014 Federal Register, the Department of Labor (“DOL”) indicated it will delay enforcement of the Companion Services Rule (“Rule”) until June 30, 2015 (the “Notice”). The DOL suggests this delayed enforcement is meant to assist the provider community with implementing changes in the Rule. In its commentary, the DOL suggests that…Read More

The recent report by the Institute of Medicine on the United States graduate medical education system, Graduate Medical Education That Meets the Nation’s Health Needs1 (“IOM Report”), advances many structure reform themes that have appeared in other assessments in recent years.  However, it goes much further.  The IOM Report calls for fundamental changes to the…Read More

Was Job Restructuring Reasonable?  The Jury Will Decide A hairdresser at a nursing home quit her job following surgery when her boss failed to consider assigning her duties of transporting wheelchair bound residents to the beauty salon to orderlies.  She filed an ADA suit claiming a failure to reasonably accommodate her disability.  The nursing home…Read More

Several FCA opinions have been issued since the last FCA Update. The most interesting is a District of Nevada case, US ex rel Guardiola v Renown Health. Renown Health was the parent company for two other corporate defendants that provided acute health care services. The relator was Renown’s Director of Clinical Compliance. She alleged Renown improperly billed “zero-day…Read More