OIG 2015 Work Plan – Home Health

Recently, the Department of Health and Human Services Office of the Inspector General (the OIG) released its work plan for 2015. The work plan provides stakeholders with a road map to  the OIG’s activities in the coming year as they relate to its enforcement priorities and issues it will review and evaluate during the year. This post is one in a series that will outline the OIG’s activities, in 2015, for a specific industry sector – Home Health.

Prospective Payment System Requirements

A prior OIG report found that one in four home health agencies (HHAs) had questionable billing. With this new initiative the OIG is going to review HHA compliance with various aspects of the home health PPS, including the documentation required to support claims.

Employment of Individuals with Criminal Convictions

OIG is going to review the extent to which HHAs employed individuals with criminal convictions and whether or not employees with potentially disqualifying convictions were employed by HHAs.

For more information on the OIG’s 2015 Work Plan and priorities, home health services and Medicare, please feel free to contact Ari Markenson at amarkenson@duanemorris.com or 212.692.1012.

OIG 2015 Work Plan – Skilled Nursing Facilities

Recently, the Department of Health and Human Services Office of the Inspector General (the OIG) released its work plan for 2015. The work plan provides stakeholders with a road map to the OIG’s activities in the coming year as they relate to its enforcement priorities and issues it will review and evaluate during the year. This post is one in a series that will outline the OIG’s activities, in 2015, for a specific industry sector – skilled nursing facilities (SNF).

Medicare Part A Billing

The OIG remains concerned about the high levels of therapy services being provided in the SNF setting despite its understanding that beneficiary characteristics have remained unchanged in FYs 2011 to 2013. It is going to continue to evaluate how CMS changes have and will effect these billing patterns.

Part B Services During Nursing Home Stays

The OIG is going to evaluate what it believes are questionable billing patterns associated with nursing homes and Medicare providers for Part B services provided to nursing home residents during non-Part A stays. A series of studies will examine several broad categories of services, such as foot care. Continue reading

Duane Morris Special Counsel Michael E. Clark to Moderate Tweet Chat: Ebola and Legal Issues Raised by Reactions

Duane Morris special counsel Michael E. Clark will moderate a free Tweet Chat that is being hosted by the ABA Health Law Section on Wednesday, November 5, 2014 at 12:00 noon EST/11:00 a.m. CST.

About the Program

The Health Law Section’s second Tweet Chat will be held on Wednesday, November 5, 2014 at 12:00 noon EST / 11:00 am CST. The hashtag for the Tweet Chat will be #HLSChat. The Section’s Twitter account is @abahealthlaw. Follow the account for more information. The moderator for the chat will be the Section’s Chair, Michael Clark (@MichaelEClark). Also participating will be Kirk Nahra, @KirkJNahrawork an expert on privacy issues, and Melissa Markey, an expert on pandemics.

The topic is Ebola and legal issues raised by reactions. This is a popular topic in light of many fears about an outbreak in the United States and wanting to learn about treatment of individuals who have come back with the virus. Please join us to discuss these issues and share your ideas, thoughts and insights.

CMS Extends Period of Exemption for Hospices Affected by Nursing Shortage

On October 3, 2014, CMS issued S&C: 12-43-Hospice entitled “Impact of Nursing Shortage on Hospice Care”.

In the memorandum, CMS explains that the Bureau of Labor Statistics continues to forecast a shortage of nurses through 2022. As a result, CMS is extending the time period in which Hospices can qualify for an “extraordinary circumstance” exemption when they believe that the nursing shortage has affected their ability to directly hire sufficient numbers of nurses.

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CMS Issues Transmittal 192 – Cleaning Up HHA Definition of “Confined to the Home”

On August 1, 2014, CMS issued Transmittal 192, specifically updating section 60.4.1 of Chapter 15 of the Medicare Benefit Policy Manual (Pub 100-02) to provide clarification of the definition of “confined to the home” (homebound). The update is intended to bring the manual guidance in line with the 2012 HH PPS final rule that was published on November 4, 2011 (76 FR 68599-68600. The clarification was recommended by the Office of Inspector General (OIG).

CMS states that the changes closely align the policy manual with the requirements of the Social Security Act. The new clarification is intended to prevent confusion, promote a clearer enforcement of the statute, and provide more definitive guidance to HHAs in order to foster compliance.

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CMS Extends Moratoria for the Enrollment of New Home Health Agencies and Ambulance Suppliers and Providers

Earlier in July of 2013 and February of this year, CMS flexed its regulatory muscle to establish temporary moratoria on the enrollment of certain providers and suppliers under its recent authority pursuant to 42 USC §42 U.S.C. 1395cc(j)(7) and 42 CFR §424.570.

In its Federal Register Notice on issued on July 31, 2013 (78 FR 46339), it imposed moratoria on the enrollment of home health agencies in Miami-Dade County, Florida and Cook County, Illinois and surrounding counties and on the enrollment of ground ambulance suppliers in the Harris County, Texas area and surrounding counties. Then, in a Federal Register Notice published on February 4, 2014 (79 FR 6475), it imposed moratoria on the enrollment of home health agencies in Broward County, Florida, Dallas County, Texas and Wayne County, Michigan and surrounding counties and on the enrollment of ground ambulance suppliers in Philadelphia, PA and surrounding counties.

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HIPAA Enforcement on the Rise, Criminal Prosecutions Become More Prevalent

As the Federal Government has moved to more aggressive enforcement of the Health Insurance Portability and Accountability Act (“HIPAA”) privacy provisions, providers and payers are experiencing significant challenges responding to and addressing privacy violations. A subset of aggressive enforcement efforts is the effort in specific circumstances to bring criminal prosecutions.

Earlier this month, The U.S. Attorney for the Eastern District of Texas announced a criminal indictment of a former employee of an East Texas Hospital for criminal violations of the HIPAA. The former employee was indicted on charges of Wrongful Disclosure of Individually Identifiable Health Information. According to the indictment, from December 1, 2012, through January 14, 2013, the employee obtained protected health information with the intent to use the information for personal gain.

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Duane Morris Special Counsel Michael E. Clark to Present on “The Physician and Attorney Relationship in a Fraud Audit”

Duane Morris special counsel Michael E. Clark will be speaking on “The Physician and Attorney Relationship in a Fraud Audit: Working Through Related Ethical Issues,” during the Physicians Legal Issues Conference presented by the American Bar Association Health Law Section in conjunction with the Chicago Medical Society and the American College of Physician Executives. Mr. Clark’s presentation will be on Friday, June 13, 2014 from 8:00 a.m. until 9:15 a.m. at the Palmer House Hilton in Chicago.

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Duane Morris Partner Mitch Goldman to Speak at Digital Health Innovation in Context 2014 Conference

Duane Morris partner C. Mitchell Goldman will speak at the Digital Health Innovation in Context 2014 Conference, to be held on April 24, 2014 from 8 a.m. to 6 p.m. at the Westin Forrestal Village in Princeton, New Jersey.

Digital Health Innovation in Context 2014 is a one-day conference focused on the world of digital health: strategy, opportunities and innovation. The intimate conference setting accompanied by the roster of healthcare executives, entrepreneurs, and investors will not only expose you to the ideas shaping the digital health landscape, but also provide you with the opportunity to meet the people reshaping the healthcare industry.

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Duane Morris’ Mark J. Silberman and Michael E. Clark Quoted in Physician Risk Management

Duane Morris partner Mark J. Silberman in the firm’s Chicago office and special counsel Michael E. Clark in the firm’s Houston office are quoted in two articles in the May 1, 2014, issue of Physician Risk Management.

In the article, “‘Dramatically Different’ Burden of Proof Required for Criminal Prosecution,” Mr. Silberman shares his insights on the malpractice case discussed in the article.

In addition, Mr. Silberman and Mr. Clark contribute their thoughts in the article, “‘Clear Pattern’ to Successful Prosecutions for Improper Opioid Prescribing,” which explores the prosecution of physicians for improperly prescribing opioids.