CMS Postpones Pre-Claim Review Demonstration for Home Health Services

Posted in Healthcare Law, Medicare & Medicaid

The Centers for Medicare & Medicaid Services (CMS) announced that it would postpone the initiation of the CMS Pre-Claim Review Demonstration for Home Health Services (the “Demonstration”) in Florida, which was scheduled to begin in October 2016. The start dates for Texas, Michigan and Massachusetts, which are also part of the Demonstration, have not yet been announced, but were originally scheduled to commence in Texas in 2016 and in Michigan and Massachusetts in 2017. Continue Reading

When a Discount May be a Kickback

Posted in Healthcare Law, Healthcare Litigation, Physicians

Healthcare providers of all kinds, as well as medical equipment suppliers, have traditionally relied upon discounts as a legitimate means of attracting patients and commercial clients without running afoul of the federal anti-kickback statute (AKS). Congress specifically created the discount “safe harbor” to the AKS years ago based on its policy of encouraging discounts that are properly disclosed as a means of reducing overall health care costs. However, the U.S. government filed a position paper in federal court this month contending that the discount safe harbor does not protect discounts that are conditioned on more than just the purchase of a product or service, such as conditioning the discount on a retailer’s efforts to convert patients to using a manufacturer’s products. Continue Reading

Former Home Health Agency Owner Sentenced to 20 Years for $57MM Medicare Fraud

Posted in Fraud & Abuse & False Claims Act, Government Affairs, Licensure & Regulatory, Healthcare Law, Healthcare Litigation, Medicare & Medicaid

The US Department of Justice announced that Khaled Elbeblaswy, the former owner and manager three Miami-area home health agencies, was sentenced to 20 years in prison and ordered to pay $36.4 million in restitution for his role in a $57 million Medicare fraud scheme. Continue Reading

The Board of Pharmacy’s 40 Hour Rule is Dead! Long live the 20 Hour Rule! Community Pharmacy Ownership Rule Change Creates new Opportunities

Posted in Government Affairs, Licensure & Regulatory, Healthcare Law

The Florida Board of Pharmacy (BOP) recently amended the rules regarding community pharmacy hours of operation to reduce required daily operating hours from 40 to 20 hours per week. As before, the hours have to be posted and the pharmacy must have a policy and procedure for transferring prescriptions and addressing emergency doses. Continue Reading

11th Circuit Awards Humana Double Damages Under Medicare Secondary Payer Act

Posted in Health Insurers & Managed Care Organizations, Healthcare Law, Healthcare Litigation, Medicare & Medicaid

Humana Medical Plan, Inc. v. Western Heritage Insurance Co., case number 15-11436.

Liability insurers beware, as the 11th Circuit held that Medicare Advantage Organizations (MAO) are entitled to the same rights Medicare itself would have in actions against primary payers for reimbursement of conditional healthcare treatment costs.  Continue Reading

HHS Issues Final Non-Discrimination Rules for Healthcare Providers

Posted in Affordable Care Act and Other Healthcare Reform Legislation, Healthcare Law, Hospitals & Health Systems

Healthcare providers and others who receive federal financial assistance are now subject to new non-discrimination rules and notice requirements under the Affordable Care Act. The new regulation prohibits discrimination in healthcare programs and activities on the basis of race, color, national origin, age, disability and sex – including pregnancy, gender identity, and sex stereotyping. The new rule also encompasses the obligation to provide language assistance services free of charge to persons with limited English proficiency. Continue Reading

Brief Reprieve Before Hospitals Must Provide Medicare Patients with “Observation” Notices

Posted in Healthcare Law, Hospitals & Health Systems, Medicare & Medicaid

Hospitals now have additional time before they must meet federal requirements to provide written notice to Medicare patients who are receiving observation services. Congress passed the Notice of Observation Treatment and Implication for Care Eligibility Act (NOTICE Act) in 2015, in response to patient confusion and complaints related to hospital observation stays. The rules were expected to be effective in August 2016. The Centers for Medicare and Medicaid Services (CMS) announced on August 2, 2016, that hospitals will have to begin delivering notices effective October 1, 2016. Continue Reading

Illinois’ Largest Health System Agrees to Stringent HIPAA Breach Settlement

Posted in HIPAA, Privacy, and Data Security, Hospitals & Health Systems

The Department of Health and Human Services Office for Civil Rights (OCR) announced on August 4, 2016, a settlement agreement with Advocate Health Care Network, an integrated healthcare system with ten hospitals and a non-profit medical group of more than 1,500 physicians in Illinois (the System or Advocate). The System agreed to adopt a corrective action plan and to pay $5.5 million to settle potential HIPAA violations related to three separate data breach incidents in 2013. The settlement is the largest to-date by OCR with a single entity. Continue Reading

Anti-Discrimination, Language Access Rules Compliance Deadline Fast Approaching for Health Insurers

Posted in Affordable Care Act and Other Healthcare Reform Legislation, Health Insurers & Managed Care Organizations

Health insurers and HMOs have a limited time to review the new federal meaningful access rules and amend plan documents accordingly. However, many payors still have not revised their plans to include the required language, and others might not be aware the rules apply to them. Continue Reading

Insurers Challenge Retroactive Application of New Florida Law that Requires Comparison of Names of Accounts to Death Master File

Posted in Government Affairs, Licensure & Regulatory, Health Insurers & Managed Care Organizations

Amendments to the Florida Disposition of Unclaimed Property Act in 2016 made significant changes to unclaimed property presumptions and insurance company obligations. See § 717.107, Fla. Stat. (2016) (the Act). Among other things, the Act: (a) revises conditions of when certain insurance policies or annuity contracts are deemed matured and the proceeds are due and payable; (b) requires  insurance companies to compare their records of life or endowment insurance policies, annuity contracts, and retained asset accounts against the United States Social Security Administration Death Master File (DMF) to determine whether a death is indicated, to update certain records, and to remit to the State of Florida any unclaimed funds within five years after a policyholder’s date of death; and (c) provides for a presumption of death for individuals whose names are contained in the DMF. Importantly, the Act specifies that it is remedial and applies to all policies entered into after July 1, 1992. Ch. 2016-219, § 2, Laws of Fla. (2016).  Continue Reading

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